CHIEF COMPLAINT: fluttering of left eye lid

PRESENT ILLNESS: 78-year-old female with a history of a brain aneurysm that we
have been following conservatively.  She has had a recent
episode of fluttering of her left eyelid. A routine CTA was
performed and showed mild enlargement of the left ICA aneurysm.
This was discussed with the patient and she electively decided
to proceed with embolization.

MEDICAL HISTORY: HTN, hypercholesterolemia and hypothyroidism.

MEDICATION ON ADMISSION: Lipitor, Nexium, gabapentin, hydrochlorothiazide, Levoxyl,
lidocaine, lorazepam, Benicar, sucralfate and triamcinolone.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Discharge:
A&Ox3
PERRL
EOMs intact
face symmetric, tongue midline
No pronator drift, slight bilateral tremor
MAE symmetrically and to command
Groin site intact with old staining, soft, no hematoma
bilateral dorsalis pedis pulses 2+

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: She is retired, previously worked as a secretary and quit
smoking seven years ago.  She had a very heavy history of
smoking prior to that for almost 40 years.
Cerebral aneurysm, nonruptured,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified hereditary and idiopathic peripheral neuropathy,Esophageal reflux,Personal history of tobacco use
Nonrupt cerebral aneurym,Hypertension NOS,Pure hypercholesterolem,Hypothyroidism NOS,Idio periph neurpthy NOS,Esophageal reflux,History of tobacco use
Admission Date:  [**2193-6-5**]              Discharge Date:   [**2193-6-6**]

Date of Birth:  [**2114-11-20**]             Sex:   F

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
fluttering of left eye lid

Major Surgical or Invasive Procedure:
[**2193-6-5**]- cerebral angiogram with coiling of L ICA


History of Present Illness:
78-year-old female with a history of a brain aneurysm that we
have been following conservatively.  She has had a recent
episode of fluttering of her left eyelid. A routine CTA was
performed and showed mild enlargement of the left ICA aneurysm.
This was discussed with the patient and she electively decided
to proceed with embolization.


Past Medical History:
HTN, hypercholesterolemia and hypothyroidism.


Social History:
She is retired, previously worked as a secretary and quit
smoking seven years ago.  She had a very heavy history of
smoking prior to that for almost 40 years.


Family History:
non-contributory

Physical Exam:
On Discharge:
A&Ox3
PERRL
EOMs intact
face symmetric, tongue midline
No pronator drift, slight bilateral tremor
MAE symmetrically and to command
Groin site intact with old staining, soft, no hematoma
bilateral dorsalis pedis pulses 2+


Pertinent Results:
Angiogram [**2193-6-5**]: successful coiling of L ICA, final read
pending at time of discharge

Brief Hospital Course:
Pt electively presented and underwent a cerebral angiogram with
coiling of the left internal carotid artery aneurysm. This was
performed without complication. She was extubated and
transferred to the ICU for close neurological monitoring. On
post op exam patient remained intact, groin intact. Her HOB was
slowly elevated overnight. On [**6-6**], patient remained stable. She
was OOB and eating appropriately. Her pain was well controlled.
She was discharged home.

Medications on Admission:
Lipitor, Nexium, gabapentin, hydrochlorothiazide, Levoxyl,
lidocaine, lorazepam, Benicar, sucralfate and triamcinolone.


Discharge Medications:
1. Docusate Sodium 100 mg PO BID
RX *Colace 100 mg twice a day Disp #*60 Tablet Refills:*2
2. Aspirin 325 mg PO DAILY
RX *aspirin 325 mg once a day Disp #*90 Tablet Refills:*2
3. Hydrochlorothiazide 12.5 mg PO DAILY
4. Multivitamins 1 TAB PO DAILY
5. NexIUM *NF* (esomeprazole magnesium) 40 mg ORAL QDAY
6. Sucralfate 1 gm PO Q8H:PRN stomach pain
7. Atorvastatin 40 mg PO DAILY
8. Benicar *NF* (olmesartan) 20 mg Oral qday
9. Gabapentin 100 mg PO BID
10. Levothyroxine Sodium 75 mcg PO DAILY
11. Lidocaine 5% Patch 1 PTCH TD DAILY
apply for 12 hours then remove for 12 hours
12. Acetaminophen 650 mg PO Q6H:PRN pain


Discharge Disposition:
Home

Discharge Diagnosis:
left internal carotid artery aneurysm


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Angiogram with Embolization and/or Stent placement
Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **]

Medications:
??????	Take Aspirin 325mg (enteric coated) once daily.
??????	Continue all other medications you were taking before surgery,
unless otherwise directed
??????	You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort.

What activities you can and cannot do:
??????	When you go home, you may walk and go up and down stairs.
??????	You may shower (let the soapy water run over groin incision,
rinse and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
??????	No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal).
??????	After 1 week, you may resume sexual activity.
??????	After 1 week, gradually increase your activities and distance
walked as you can tolerate.
??????	No driving until you are no longer taking pain medications


Followup Instructions:
* Please call [**Telephone/Fax (1) 1669**] to make a follow up appointment with
Dr. [**First Name (STitle) **] in 4 weeks. You will need the no imaging at this
appointment.

You will also need to follow up in 6 months with an MRI/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
protocol. Please call [**Telephone/Fax (1) 1669**] to schedule.



Completed by:[**2193-6-6**]
{'Cerebral aneurysm, nonruptured,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified hereditary and idiopathic peripheral neuropathy,Esophageal reflux,Personal history of tobacco use'}


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: fluttering of left eye lid

PRESENT ILLNESS: 78-year-old female with a history of a brain aneurysm that we
have been following conservatively.  She has had a recent
episode of fluttering of her left eyelid. A routine CTA was
performed and showed mild enlargement of the left ICA aneurysm.
This was discussed with the patient and she electively decided
to proceed with embolization.

MEDICAL HISTORY: HTN, hypercholesterolemia and hypothyroidism.

MEDICATION ON ADMISSION: Lipitor, Nexium, gabapentin, hydrochlorothiazide, Levoxyl,
lidocaine, lorazepam, Benicar, sucralfate and triamcinolone.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Discharge:
A&Ox3
PERRL
EOMs intact
face symmetric, tongue midline
No pronator drift, slight bilateral tremor
MAE symmetrically and to command
Groin site intact with old staining, soft, no hematoma
bilateral dorsalis pedis pulses 2+

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: She is retired, previously worked as a secretary and quit
smoking seven years ago.  She had a very heavy history of
smoking prior to that for almost 40 years. 

### Response:
{'Cerebral aneurysm, nonruptured,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified hereditary and idiopathic peripheral neuropathy,Esophageal reflux,Personal history of tobacco use'}
