CHIEF COMPLAINT: altered mental status

PRESENT ILLNESS: Patient is a 20 yo Portuguese speaking female with PMH of
migraines who presented to [**Hospital 17065**] Hospital on [**2118-6-1**] with
altered mentalstatus.  Started with a transient episode of
distorted facial features and inability to speak.  Went to ED on
[**5-25**] complaining of dizziness, headache and nausea and was
treated for migraine with zofran, and apparently responded.
Then [**5-28**] presented again complaining of headache, vomitting and
peri-oral numbness.  There were no meningeal signs on either of
these visits, and she had a normal physical exam.  [**6-1**]
presented with MS changes after having a period of face
twitching which lasted minutes.  There was no involvement of
arms or legs per
cousin.  CT at that time showed a tiny focus of low attenuation
in the right frontal lobe in the subcortical area.  An LP showed
protein of 237, glucose 14, 100 nucleated cells in the CSF only
1 of which was a PMN.  CSF studies for HSV 1 and 2 pending.
Other studies were ordered, but unfortunately not sent secondary
to a lab tech spilling 15 cc of her CSF fluid.

MEDICAL HISTORY: Migraines.  Has never been hospitalized prior to this.

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T- 99.0  BP-  99/57   HR- 75   RR- 19  O2Sat  99 RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: Moderate tenderness to palpation, mild rigidity, no
carotid
or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: No FH of neurologic disease.

SOCIAL HISTORY: She is from [**Location (un) 78675**], [**Country 4194**] and is living in [**Hospital1 3494**] for
the last 2 months on a student VISA studying english. She denies
ETOH or illicit drug use.
Tuberculous meningitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture,Tuberculous pneumonia [any form], tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture,Obstructive hydrocephalus,Atony of bladder,Other convulsions,Retention of urine, unspecified
TB meningitis-cult dx,TB pneumonia-cult dx,Obstructiv hydrocephalus,Atony of bladder,Convulsions NEC,Retention urine NOS
Admission Date:  [**2118-6-4**]              Discharge Date:   [**2118-6-28**]

Date of Birth:  [**2098-1-6**]             Sex:   F

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 21193**]
Chief Complaint:
altered mental status

Major Surgical or Invasive Procedure:
Lumbar puncture

History of Present Illness:
Patient is a 20 yo Portuguese speaking female with PMH of
migraines who presented to [**Hospital 17065**] Hospital on [**2118-6-1**] with
altered mentalstatus.  Started with a transient episode of
distorted facial features and inability to speak.  Went to ED on
[**5-25**] complaining of dizziness, headache and nausea and was
treated for migraine with zofran, and apparently responded.
Then [**5-28**] presented again complaining of headache, vomitting and
peri-oral numbness.  There were no meningeal signs on either of
these visits, and she had a normal physical exam.  [**6-1**]
presented with MS changes after having a period of face
twitching which lasted minutes.  There was no involvement of
arms or legs per
cousin.  CT at that time showed a tiny focus of low attenuation
in the right frontal lobe in the subcortical area.  An LP showed
protein of 237, glucose 14, 100 nucleated cells in the CSF only
1 of which was a PMN.  CSF studies for HSV 1 and 2 pending.
Other studies were ordered, but unfortunately not sent secondary
to a lab tech spilling 15 cc of her CSF fluid.

She was started initially on Acyclovir, Vancomycin, Rocephin,
and at the time of transfer was on Acyclovir, Rocephin, Flagyl
and Azithromycin.  She has also been loaded and covered with
Dilantin.  At OSH has had some occasional fevers upt to 101.2 on
[**6-2**] and 102.4 on [**6-1**].

ROS:  Patient denies any ill contacts.  Had travelled down to
[**Location (un) 78673**], [**MD Number(3) 78674**] 2 weeks prior to getting sick.  Does not
recall any insect bites.  Has intermittne N/V.  Has frontal
headache [**7-14**]. Denies recent chills, cough, sputum, SOB.  No
dirrhea or belly pain.  Some generalized weakness and muscle
aches, but no joint pain or swelling.  No rash.  No URI
symptoms.


Past Medical History:
 Migraines.  Has never been hospitalized prior to this.


Social History:
She is from [**Location (un) 78675**], [**Country 4194**] and is living in [**Hospital1 3494**] for
the last 2 months on a student VISA studying english. She denies
ETOH or illicit drug use.

Family History:
No FH of neurologic disease.

Physical Exam:
T- 99.0  BP-  99/57   HR- 75   RR- 19  O2Sat  99 RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: Moderate tenderness to palpation, mild rigidity, no
carotid
or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

Neurologic examination:
Mental status: Awake and alert, cooperative with exam, flat
affect.  Oriented to person, place.  Inattentive with portions
of
the exam.  Speech is fluent with normal comprehension;  No
dysarthria. No evidence of apraxia or neglect.

Cranial Nerves:  Papilledema of left eye. Could not cooperate
with right.
Could not cooperate with VF testing. Pupils [**4-6**] on the right and
6-4on left, with left being somewhat sluggish. Extraocular
movements intact bilaterally, no nystagmus. Sensation intact
V1-V3.  Facial movement symmetric.  Hearing intact to finger rub
bilaterally.  Palate elevation symmetrical.  Sternocleidomastoid
and trapezius normal bilaterally. Tongue midline, movements
intact

Motor:
Normal bulk bilaterally. Tone normal. No observed myoclonus or
tremor
No pronator drift

Could not cooperate with complete motor exam and had giveway
weakness many times on exam.  Was full strength in Deltoids
bilaterally.  Perhaps some slight weakness at left tricep, IP
and
DF, but difficult to be sure.

Sensation: Intact to light touch throughout.
Reflexes:
+2 and symmetric throughout UE.   2 at knees/ankles.
Toes withdrawl bilaterally

Coordination: finger-nose-finger normal, fingertaps nl.

Gait: not assessed

Labs: pending


Pertinent Results:
MR HEAD W & W/O CONTRAST  [**2118-6-4**] 11:16 PM

MR HEAD W & W/O CONTRAST

Reason: right frontal hypodensity?
Contrast: MAGNEVIST

[**Hospital 93**] MEDICAL CONDITION:
20 year old woman with encephalitis, seizure and right frontal
hypodensity
REASON FOR THIS EXAMINATION:
right frontal hypodensity?
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 20-year-old female patient, with encephalitis,
seizure, right frontal hypodensity, for further evaluation.

COMPARISON: CT of the head done on [**2118-6-4**].

TECHNIQUE: Multiplanar T1- and T2-weighted imaging of the head
was performed without and with IV contrast.

FINDINGS:

This study is somewhat limited due to motion artifacts. On the
axial FLAIR sequence, there is increased signal noted in the
cerebral sulci, diffusely, as well as in the basal cisterns with
some enhancement on the post-contrast images, in addition to the
enhancement of the venous structures within the sulci. This is
concerning for leptomeningeal inflammation or infection.
However, no focal intraparenchymal lesions are noted. The
ventricles appear unremarkable. There are no areas of restricted
diffusion in the brain parenchyma. The previously described
hypodensity on the CT scan, represents a small perivascular
space, suppressed on the FLAIR sequence (series 7, image 11).

The major vascular flow voids are noted. The visualized portions
of the paranasal sinuses are unremarkable.

IMPRESSION:

1. Diffuse increase in the FLAIR signal intensity in the
cerebral sulci, and basal cisterns, with some enhancement on the
post-contrast images (in addition to the enhancement of the
venous structures), can represent leptomeningeal inflammation or
infection. To correlate clinically and with LP results and
consider followup MRI, if clinically indicated.

2. No obvious intraparenchymal lesions or areas of restricted
diffusion, noted on the present study.

EEG: [**2118-6-11**]
This is an abnormal portable EEG due to the slow and
disorganized background admixed with bursts of generalized mixed

frequency slowing. This constellation of findings is consistent
with a
mild encephalopathy and suggests dysfunction of bilateral
subcortical or
deep midline structures. Medications, metabolic disturbances,
and
infection are among the common causes of encephalopathy but
there are
others. There were no areas of prominent focal slowing although
encephalopathic patterns can sometimes obscure focal findings.
There
were no clearly epileptiform features and no electrographic
seizure
activity was noted.

CT CHEST W/CONTRAST  [**2118-6-6**] 6:05 PM
FINDINGS: Large parts of the left upper lobe, notably the apical
and the posterior segment, are occupied by a widespread
parenchymal pathology. This pathology is partly consolidated and
partly has micro and macronodular components. The micronodular
components show multiple air bronchograms and one of these
micronodular lesions might show early signs of cavitation. The
bronchi adjacent to the lesions are slightly dilated. In the
peribronchial areas, confluenting micronodules create the
appearance of subtle ground-glass opacities. The lesions reach
out to the pleural surfaces, as a consequence, the major fissure
is slightly thickened. The lesions are confined to the left
upper lobe. No similar lesions are seen in the remaining lung.
The remaining lung displays a slightly elevated general
attenuation which might partly be due to an insufficient
inspiratory effort. There is no evidence of pleural effusions.
There are scars paraaortic lymph nodes of borderline size, no
other mediastinal lymph nodes are seen, notably in paratracheal
location. There are no enlarged lymph nodes amenable to biopsy.
The appearance of the mediastinal and intrapulmonary vessels is
unremarkable.

IMPRESSION: Micro and macronodular consolidations in the left
upper lobe, with local bronchiectasis, air bronchograms and
early signs of cavitation. Overall, these findings are strongly
suggestive of tuberculosis. The lesions predominate in the
apical and posterior segment of the left upper lobe. There is no
evidence of enlarged mediastinal lymph nodes in the paratracheal
location that might be amenable to transtracheal biopsy.

CT HEAD W/O CONTRAST  [**2118-6-9**] 9:09 AM

FINDINGS: There is interval new, moderate ventriculomegaly,
involving all the ventricles, with few areas of periventricular
hypodensities, most prominent around the left temporal [**Doctor Last Name 534**]
(series 3, image 9). This appearance, given the history of
tuberculous meningitis, can relate to communicating
(extraventricular obstructive) hydrocephalus, the
periventricular hypodensities, being due to seepage of the CSF
vs. involvement of the adjacent parenchyma itself. There is no
evidence of hemorrhage or shift of midline structures. There is
mild mass effect on the anterior part of the temporal [**Doctor Last Name 534**], by
the periventricular hypodensity (series 3, image 9). No osseous
lytic or sclerotic lesions are noted. The overlying soft tissues
of the scalp are unremarkable. The visualized portions of the
paranasal sinuses are clear.

IMPRESSION:
1. Moderate ventriculomegaly, involving all the ventricles, with
the given history of tuberculous meningitis, can relate to
communicating or extraventricular obstructive hydrocephalus.
2. Small area of periventricular hypodensity, around the left
temporal [**Doctor Last Name 534**], with mild mass effect on the anterior aspect of
the temporal [**Doctor Last Name 534**], can relate to focal parenchymal hypodensity
or the seepage of the CSF fluid. If parenchymal abnormalities
are to be excluded, MR of the head can be considered, if
necessary.

CT HEAD W/O CONTRAST  [**2118-6-11**] and [**2118-6-14**] showed no interval
changes when compared to the study on [**2118-6-9**].

CT HEAD- [**2118-6-22**]-
In comparison with the prior study, there is evidence of mild
improvement in the ventricular size, with less effacement of the
sulci as described in detail above.

([**2118-6-8**]) Bronchoaveolar Lavage - Smear positive for acid fast
bacilli.

([**2118-6-10**]) Gen-probe amplified MTD test positive for
Mycobacterium tubercolosis.

AFB were grown in culture.

HIV-1 Antibody test was negative.


Brief Hospital Course:
Ms. [**Known lastname 1794**] is a 20 year old woman from [**Country 4194**] who was here in
[**Location (un) 86**] studying English and presented with subacute onset of
headache and later neck pain, transferred to the neurology
service at [**Hospital1 18**] from [**Hospital3 15286**] following CSF profile
revealed protein of 237, glucose 14, 100 nucleated cells, 1 of
which was a PMN, in the setting of mental status changes.

1) TB meningitis-
The pt had a positive PPD from the outside hospital and was
placed on TB precautions in a negative pressure room and
admitted to the neurology service. ID was consulted on
admission. Repeat LP revealed total protein 183, Glucose 22, WBC
160, RBC 40, 73% Lymphocytes. Left upper lobe infiltrate on CXR
was further evaluated by chest CT, then BAL returned AFB
positive smear and positive for TB with amplified MTD test. She
was started on Rifampin, Pyrazinamide, Ethambutol, Isoniazid for
treatment of presumed TB meningitis. She was also treated with
dexamethasone for concurrent arachnoiditis. Cryptococcal antigen
was negative. There were no malignant cells notable on cytology
of her CSF ruling out the two other predominent mechanisms that
could potentially produce her CSF profile in the clinical
setting of chronic meningitis. Remainder of hospital course is
delineated by problem below.

2) Neurologic sequelae-
The patient c/o headache and was visibly somnolent during her
initial hospital course. On [**6-6**] pt was noted to have a LMN
bladder with 1000cc of retained urine, leg weakness/flaccidity,
and anisorcoria due to CN II involvement. These findings were
all localisable to arachnoiditis. T/L-spine MR [**First Name (Titles) 3780**] [**Last Name (Titles) **]e leptomeningeal enhancement of the entire cord and cauda
equina c/w arachnoiditis. A head CT on [**2118-6-9**] [**Date Range 3780**]
global ventriculomegaly with a questionable focus of
hypointensity in the left temporal lobe that could represent
ependymal CSF flow vs parenchymal disease; later repeat head CT
revealed resolution of this abnormality. Neurosurgery was
consulted in the setting of communicating hydrocephalus and felt
that the pt did not need to be shunted, but rather should
undergo medical therapy Diamox and Lasix. Due to progression of
her headache and somnolence, the patient was transfered to the
MICU from [**6-10**] to [**6-15**]. The pt's mental status, cognition, HA
and general appearance improved so she was transferred out of
the MICU.

These deficits have not worsened, but have only shown minimal
improvement at the current time. Physical therapy has been
working with the patient.

During this time, the patient was on seizure ppx with dilantin
initially; however, due to the liver metabolism of her
tuberculosis antibiotics, she was switched to Keppra. She has
not had any seizures during her course. She will follow up with
[**First Name8 (NamePattern2) 10378**] [**Last Name (NamePattern1) 14440**] and Dr. [**First Name8 (NamePattern2) 9485**] [**Last Name (NamePattern1) **] of the Neurology Service.

3) Infectious Disease-
The patient was initially started on Isoniazid, pyrazinamide,
ethambutol, rifampin, Vit B6, decadron. Routine LFTs and
pancreatic enzymes showed a transient elevation of amylase and
lipase to the low 100s. During her course, she would
intermittently complain of diffuse abdominal pain without
peritoneal signs and did not affect her excellent appetite. On
[**6-13**] a CT abdomen/pelvis was unremarkable. Serial LFT's and
amylase, lipase measurements were stable. She will continue with
directly observed therapy through the City of [**Hospital1 3494**]
Department of Health as an outpatient. Her case manager is [**First Name5 (NamePattern1) **]
[**Last Name (NamePattern1) 78676**] [**Telephone/Fax (1) 78677**]. She will follow up with Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] of the Infectious Disease Service at [**Hospital1 18**].
Duration of four drug TB therapy is one year.

4) Bladder distention-
The patient has a lower motor neuron bladder resulting from
spinal arachnoiditis. She was seen by the urology clinic nurse
practitioner, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7986**], for teaching of intermittent self
catheterization. It is difficult to predict whether she will
regain full contractile function of her bladder. She will follow
up for urodynamics testing as an outpatient, pending results of
the study she will need to be seen by the urology resident
clinic for further care.

5) [**Name (NI) 78678**]
Pt was seen by the opthalmology service and noted to have
papilledema as previously described. Her anisocoria is likely
secondayr to arachnoiditis affecting CN III as it follows CN II.
Her color testing while on ethambutol was normal. Her visual
fields were full. She will see Dr. [**First Name (STitle) **] [**Name (STitle) **] in
[**Hospital 78679**] clinic as an outpatient for follow up in the
next 2-3 weeks for repeat color vision testing, visual fields
and full ophthalmologic exam while on antiTB treatment.

Social-
The patient plans to continue with her english classes here in
the United States until [**Month (only) **] and then return to [**Country 4194**]
where she will continue law school. She will require regular
surveillance by infectious disease, neurologists and urologists
once she returns to [**Country 4194**] for safety labs while on INH,
Rifampin, pyrazinamide and ethambutol, as well as for treatment
of long term sequelae of her infection.

Medications on Admission:
None

Discharge Medications:
1. Isoniazid 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. Pyridoxine 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Rifampin 300 mg Capsule Sig: Two (2) Capsule PO Q24H (every
24 hours).
Disp:*60 Capsule(s)* Refills:*0*
4. Ethambutol 400 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*0*
5. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Pyrazinamide 500 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*0*
7. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 7 days: Take three times a day until [**7-5**]. Then
take two times per day until [**7-19**]. Then take one tablet per
day until [**8-2**].
Disp:*42 Tablet(s)* Refills:*0*
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours) for
2 months: Continue while on steroids (dexamethasone).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
Disp:*90 Tablet, Chewable(s)* Refills:*2*
12. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain: Please call Dr. [**Last Name (STitle) 14440**] if you are
taking three times per day.


Discharge Disposition:
Home

Discharge Diagnosis:
Tuberculous meningitis.
Spinal arachnoiditis
Urinary Retention secondary to atonic lower motor neuron bladder


Discharge Condition:
Left pupil 7mm-->6mm, R pupil 6mm-->5mm, Persistent lower motor
neuron bladder (distention). Bilateral IP, Quad, Hamstring
weakness R > L. Toes downgoing.


Discharge Instructions:
You were admitted for headaches and neck pain and found to TB
meningitis.

It is essential you continue to take all medications every day
under the supervision of the department of health.

Call your doctor or 911 immediately with any symptoms of nausea,
vomiting, worsening abdominal pain, yellowing of your skin or
eyes, or any other concerns. These can be a sign of liver
problems that can result from your TB medicine and should be
addressed by a doctor immediately should they occur.

You will have weakness and bladder problems as a result of
swelling of the coverings of your brain and spinal cord. It is
important to continue with physical therapy and intermittent
self catheterization as an outpatient to help improve these
things.

Call your doctor or 911 for any change in your wakefullness,
worsening headaches, difficulty with your vision, worsening
weakness, bowel incontinence, new fevers, seizures, skin rashes,
vomiting, worsening abdominal pain or any other concerning
symptoms.

Followup Instructions:
Please keep the following appointments:
Infectious Disease: DR. [**First Name (STitle) **] [**Doctor Last Name 9406**] Date/Time:[**2118-7-28**] 9:00
Office Phone:[**Telephone/Fax (1) 457**]

Neurology:
DRS. [**Name5 (PTitle) 540**] & [**Doctor Last Name **] Date/Time:[**2118-8-2**] 12:30
Office Phone:[**Telephone/Fax (1) 44**]

Ophthalmology (for your eyes):
You should see Dr. [**First Name (STitle) **] [**Name (STitle) **] in the [**Hospital 13279**]
clinic for follow up. Office Number [**Telephone/Fax (1) 78680**]. They will call
you with an appointment time, but please call them if you do not
hear from them within 1 week.

Urology (for your bladder):
URODYNAMICS STUDY Date/Time:[**2118-7-22**] 2:00
Office Phone:[**Telephone/Fax (1) 164**]

You were seen by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7986**] MS RN,
Urology Nurse Practitioner, Office Phone [**Telephone/Fax (1) 78681**]. Depending
on the results of the above 'urodynamics study' you should
follow up in the Urology Resident Clinic to determine whether it
is safe for you to decrease how frequently you are performing
the intermittent self bladder catheterization.

You will be followed by [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 78676**] at the [**Hospital1 3494**]
Department of Health for daily TB medications- Office Number
[**Telephone/Fax (1) 78682**]. However you will be followed by the
[**Hospital 8**] Hospital [**Hospital **] clinic for getting your medications.


                             [**Name6 (MD) 3523**] [**Name8 (MD) 3524**] MD [**MD Number(2) 21196**]
{'Tuberculous meningitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture,Tuberculous pneumonia [any form], tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture,Obstructive hydrocephalus,Atony of bladder,Other convulsions,Retention of urine, unspecified'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: altered mental status

PRESENT ILLNESS: Patient is a 20 yo Portuguese speaking female with PMH of
migraines who presented to [**Hospital 17065**] Hospital on [**2118-6-1**] with
altered mentalstatus.  Started with a transient episode of
distorted facial features and inability to speak.  Went to ED on
[**5-25**] complaining of dizziness, headache and nausea and was
treated for migraine with zofran, and apparently responded.
Then [**5-28**] presented again complaining of headache, vomitting and
peri-oral numbness.  There were no meningeal signs on either of
these visits, and she had a normal physical exam.  [**6-1**]
presented with MS changes after having a period of face
twitching which lasted minutes.  There was no involvement of
arms or legs per
cousin.  CT at that time showed a tiny focus of low attenuation
in the right frontal lobe in the subcortical area.  An LP showed
protein of 237, glucose 14, 100 nucleated cells in the CSF only
1 of which was a PMN.  CSF studies for HSV 1 and 2 pending.
Other studies were ordered, but unfortunately not sent secondary
to a lab tech spilling 15 cc of her CSF fluid.

MEDICAL HISTORY: Migraines.  Has never been hospitalized prior to this.

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T- 99.0  BP-  99/57   HR- 75   RR- 19  O2Sat  99 RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: Moderate tenderness to palpation, mild rigidity, no
carotid
or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: No FH of neurologic disease.

SOCIAL HISTORY: She is from [**Location (un) 78675**], [**Country 4194**] and is living in [**Hospital1 3494**] for
the last 2 months on a student VISA studying english. She denies
ETOH or illicit drug use. 

### Response:
{'Tuberculous meningitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture,Tuberculous pneumonia [any form], tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture,Obstructive hydrocephalus,Atony of bladder,Other convulsions,Retention of urine, unspecified'}
