CHIEF COMPLAINT: Multiple intracranial meningiomas.

PRESENT ILLNESS: the patient is a 42-year old female with a history of
multiple meningiomas. She was previously operated on at [**Hospital1 2025**] by
Dr. [**Last Name (STitle) 405**] for partial resection of several of those, and now
follows up with progressive disease in several of her
intracranial meningiomas, especially on the right high
frontoparietal side with an en plaque meningioma that is being
imaged with sequential MRI scans. The patient is clinically
symptomatic by persistent headaches, which she occasionally
takes
medications for. The patient also has had symptomatic seizures
and is currently treated with Dilantin as well as baclofen and
Lamictal. The patient currently denies specific complaints such
as breakthrough seizures, nausea, vomiting, or changes in
overall
well being, including dizziness. The patient was seen by
ophthalmology for regular migraines and had a normal
neuro-ophthalmological exam.

MEDICAL HISTORY: Multiple intracranial meningioma
h/o facial reconstruciton s/p MVA

MEDICATION ON ADMISSION: FIORICET 325 mg-40 mg-50 mg--[**12-4**] tablet(s) by mouth q4-6 hrs as
needed for for headaches
INDERAL LA 80 mg--1 capsule(s) by mouth once a day
LYRICA 25 mg--1 capsule(s) by mouth twice a day start at 1 cap
[**Hospital1 **] for 1st week, increase by 1 caps in divided doses every week

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: On exam, T 99 P 72 RR 18 BP 118/70 O2sat 100% RA
Patient is awake, alert, and oriented. She has a
normal mental status and is cooperative and pleasant to work
with. She has normal speech.
Lungs: CTA
Heart: NL S1/S2; no carotid burites bilat.

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: The patient works as an executive. She is a nonsmoker and
occasional drinker.
Benign neoplasm of cerebral meninges,Hemiplegia, unspecified, affecting unspecified side,Facial weakness
Ben neo cerebr meninges,Unsp hemiplga unspf side,Facial weakness
Admission Date:  [**2171-7-18**]              Discharge Date:   [**2171-7-22**]

Date of Birth:  [**2129-3-1**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Iodine; Iodine Containing

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Multiple intracranial meningiomas.


Major Surgical or Invasive Procedure:
Right frontal craniotomy


History of Present Illness:
the patient is a 42-year old female with a history of
multiple meningiomas. She was previously operated on at [**Hospital1 2025**] by
Dr. [**Last Name (STitle) 405**] for partial resection of several of those, and now
follows up with progressive disease in several of her
intracranial meningiomas, especially on the right high
frontoparietal side with an en plaque meningioma that is being
imaged with sequential MRI scans. The patient is clinically
symptomatic by persistent headaches, which she occasionally
takes
medications for. The patient also has had symptomatic seizures
and is currently treated with Dilantin as well as baclofen and
Lamictal. The patient currently denies specific complaints such
as breakthrough seizures, nausea, vomiting, or changes in
overall
well being, including dizziness. The patient was seen by
ophthalmology for regular migraines and had a normal
neuro-ophthalmological exam.


Past Medical History:
Multiple intracranial meningioma
h/o facial reconstruciton s/p MVA

Social History:
The patient works as an executive. She is a nonsmoker and
occasional drinker.


Family History:
Non contributory

Physical Exam:
On exam, T 99 P 72 RR 18 BP 118/70 O2sat 100% RA
Patient is awake, alert, and oriented. She has a
normal mental status and is cooperative and pleasant to work
with. She has normal speech.
Lungs: CTA
Heart: NL S1/S2; no carotid burites bilat.

The patient has cranial nerves that are unremarkable except a
facial asymmetry secondary to a left facial droop that is old in
nature. The patient also has
difficulties with gait, with a limp on the left side secondary
to lower extremity weakness on the left.
The patient has generalized weakness on the left side with loss
of hip flexion, loss of left knee extension, as well as
difficulties with ankle extension and ankle flexion and wears an

orthosis. The right side is intact with full strength
throughout. The left upper extremity seems to be normal. No
sensory deficits, and the patient has symmetric reflexes.


Pertinent Results:
Post-op CT:
CT HEAD W/O CONTRAST  [**2171-7-18**] 4:00 PM

FINDINGS: There are post-operative changes consistent with
recent right frontal craniotomy and right frontal meningioma
resection. Pneumocephalus is noted. There is no evidence of
hemorrhage, edema or hydrocephalus. Other calcified meningioma
remain as previously described.

IMPRESSION: Patient is status post right frontal craniotomy.
There is pneumocephalus noted after right frontal meningioma
resection. There is no evidence of hemorrhage, edema or
hydrocephalus. Other calcified meningioma remain; these are
similar in appear


Brief Hospital Course:
Patient was admitted on [**2171-7-18**] and underwent right craniotomy
for tumor resection on the same day. There is no intra- or
post-op complications. She was extubated after the surgery.
After the surgery, she was monitored in PACU overnight and
transfered to the floor on POD#1. Dilantin levels monitored POD
2-4 up to 9.4 at time of discharge to rehab facility.  Decadron
taper was concluded on the morning of POD#4 before discharge on
[**7-22**].  Sutures/staples are to be removed POD#10 and pt to follow
up with head CT with Dr.[**Last Name (STitle) **] in 6 weeks.


Medications on Admission:
FIORICET 325 mg-40 mg-50 mg--[**12-4**] tablet(s) by mouth q4-6 hrs as
needed for for headaches
INDERAL LA 80 mg--1 capsule(s) by mouth once a day
LYRICA 25 mg--1 capsule(s) by mouth twice a day start at 1 cap
[**Hospital1 **] for 1st week, increase by 1 caps in divided doses every week

to a max of 4caps [**Hospital1 **] at the end of 4 weeks. hold increase if
excess sedation



Discharge Medications:
1. Baclofen 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO QAM (once a day (in the morning)).
6. Phenytoin 50 mg Tablet, Chewable Sig: Five (5) Tablet,
Chewable PO QPM (once a day (in the evening)).
7. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
Meningioma


Discharge Condition:
Neurologically stable


Discharge Instructions:
??????	Have a family member check your incision daily for signs of
infection
??????	Take your pain medicine as prescribed
??????	Exercise should be limited to walking; no lifting, straining,
excessive bending
??????	You may wash your hair only after sutures and/or staples have
been removed
??????	You may shower before this time with assistance and use of a
shower cap
??????	Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING:

??????	New onset of tremors or seizures
??????	Any confusion or change in mental status
??????	Any numbness, tingling, weakness in your extremities
??????	Pain or headache that is continually increasing or not
relieved by pain medication
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, drainage
??????	Fever greater than or equal to 101?????? F


Followup Instructions:
Follow up with Dr[**Name (NI) 9034**] clinic ([**Telephone/Fax (1) 1669**]) on [**7-29**] to have
staples removed
Follow up with Dr [**Last Name (STitle) **] in 6 weeks call for an appointment
- Head CT in 6 weeks
{'Benign neoplasm of cerebral meninges,Hemiplegia, unspecified, affecting unspecified side,Facial weakness'}


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: Multiple intracranial meningiomas.

PRESENT ILLNESS: the patient is a 42-year old female with a history of
multiple meningiomas. She was previously operated on at [**Hospital1 2025**] by
Dr. [**Last Name (STitle) 405**] for partial resection of several of those, and now
follows up with progressive disease in several of her
intracranial meningiomas, especially on the right high
frontoparietal side with an en plaque meningioma that is being
imaged with sequential MRI scans. The patient is clinically
symptomatic by persistent headaches, which she occasionally
takes
medications for. The patient also has had symptomatic seizures
and is currently treated with Dilantin as well as baclofen and
Lamictal. The patient currently denies specific complaints such
as breakthrough seizures, nausea, vomiting, or changes in
overall
well being, including dizziness. The patient was seen by
ophthalmology for regular migraines and had a normal
neuro-ophthalmological exam.

MEDICAL HISTORY: Multiple intracranial meningioma
h/o facial reconstruciton s/p MVA

MEDICATION ON ADMISSION: FIORICET 325 mg-40 mg-50 mg--[**12-4**] tablet(s) by mouth q4-6 hrs as
needed for for headaches
INDERAL LA 80 mg--1 capsule(s) by mouth once a day
LYRICA 25 mg--1 capsule(s) by mouth twice a day start at 1 cap
[**Hospital1 **] for 1st week, increase by 1 caps in divided doses every week

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: On exam, T 99 P 72 RR 18 BP 118/70 O2sat 100% RA
Patient is awake, alert, and oriented. She has a
normal mental status and is cooperative and pleasant to work
with. She has normal speech.
Lungs: CTA
Heart: NL S1/S2; no carotid burites bilat.

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: The patient works as an executive. She is a nonsmoker and
occasional drinker. 

### Response:
{'Benign neoplasm of cerebral meninges,Hemiplegia, unspecified, affecting unspecified side,Facial weakness'}
