CHIEF COMPLAINT: R meningioma

PRESENT ILLNESS: 45yo woman with history of headaches for at least the past 10
years. She states that she sometimes wakes up with them and
sometimes they come on over the course of the day. She takes
tylenol with moderate relief. She attributed the headaches to
stress, but underwent a CT 3 yrs ago which was reportedly
negative. Since the H/A's continued she requested an MRI which
revealed a right frontal dural based contrast enhancing mass.

MEDICAL HISTORY: PMHx: C-section, laparoscopy

MEDICATION ON ADMISSION: tylenol

ALLERGIES: CT contrast

PHYSICAL EXAM: Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs intact
Neck: Supple.
Lungs: no adventicious sounds
Cardiac: RRR
Abd: Soft, NT
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-18**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: nc

SOCIAL HISTORY: has 7year old twins. cares for 87yr old mother. [**Name (NI) **] degree,
works as a residential counsler for mentally challenged
children. No T/E/D abuse
Benign neoplasm of cerebral meninges,Cerebral edema
Ben neo cerebr meninges,Cerebral edema
Admission Date:  [**2117-5-27**]              Discharge Date:   [**2117-5-30**]

Date of Birth:  [**2071-9-2**]             Sex:   F

Service: NEUROSURGERY

Allergies:
CT contrast

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
R meningioma

Major Surgical or Invasive Procedure:
R craniotomy and meningioma resection

History of Present Illness:
45yo woman with history of headaches for at least the past 10
years. She states that she sometimes wakes up with them and
sometimes they come on over the course of the day. She takes
tylenol with moderate relief. She attributed the headaches to
stress, but underwent a CT 3 yrs ago which was reportedly
negative. Since the H/A's continued she requested an MRI which
revealed a right frontal dural based contrast enhancing mass.

Past Medical History:
PMHx: C-section, laparoscopy

All: CT contrast dye ? (N/V), ok with gadolinium

Social History:
has 7year old twins. cares for 87yr old mother. [**Name (NI) **] degree,
works as a residential counsler for mentally challenged
children. No T/E/D abuse

Family History:
nc

Physical Exam:
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs intact
Neck: Supple.
Lungs: no adventicious sounds
Cardiac: RRR
Abd: Soft, NT
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-18**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3 to 2
mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**4-22**] throughout. No pronator drift

Sensation: Intact to light touch, propioception

Coordination: normal on finger-nose-finger, rapid alternating
movements

Pertinent Results:
MRI: right frontal contrast enhancing extra axial mass with
vasogenic edema.

Post Op CT head: Post-resection of a right frontal meningioma
with expected
postoperative changes, and no evidence of large postoperative
hemorrhage or
large vascular territorial infarction.

Post Op MRI [**5-28**]:

The patient is status post right craniotomy and resection of a
right frontal meningioma, the expected surgical changes are
seen, consistent with residual blood products in the surgical
bed. There is no evidence of large post-surgical hemorrhage or
territorial infarction. Persistent unchanged vasogenic edema in
the subcortical white matter and right periatrial region.


Brief Hospital Course:
Mrs. [**Known lastname 33179**] was admitted for elective resection of a R frontal
meningioma via R craniotomy. After the procedure, she was
extubated and taken to the SICU overnight for monitoring. She
had some nausea post op that was relieved with ondansetron. Post
op CT showed no hemorrhage and expected postoperative changes.
On POD1, she was transferred to the floor, started on sch, had
her post op MRI, her aline and foley dc'd, She remained
neurologically intact. She was transferred to the floor in
stable condition. SHe was ambulating without difficulty and
tolerating a PO diet. She will be DC'd home in stable condition.


Medications on Admission:
tylenol

Discharge Medications:
1. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
4. dexamethasone 2 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Meningioma


Discharge Condition:
AOx3. Activity as tolerated.


Discharge Instructions:
??????	Have a friend/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,
or excessive bending.
??????	You may wash your hair only after sutures and/or staples have
been removed. If your wound closure uses dissolvable sutures,
you must keep that area dry for 10 days.
??????	You may shower before this time using a shower cap to cover
your head.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????	If you have been prescribed Dilantin (Phenytoin) for
anti-seizure medicine, take it as prescribed and follow up with
laboratory blood drawing in one week.  This can be drawn at your
PCP??????s office, but please have the results faxed to [**Telephone/Fax (1) 87**].
If you haven been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.
??????	Make sure to continue to use your incentive spirometer while
at home, unless you have been instructed not to.

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, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please return to the office in [**6-27**] days(from your date of
surgery) for removal of your staples/sutures and/or a wound
check. This appointment can be made with the Nurse Practitioner.
 Please make this appointment by calling [**Telephone/Fax (1) 1669**]. If you
live quite a distance from our office, please make arrangements
for the same, with your PCP.
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in 4 weeks.
??????You will need a CT scan of the brain without contrast.



Completed by:[**2117-5-30**]
{'Benign neoplasm of cerebral meninges,Cerebral edema'}


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: R meningioma

PRESENT ILLNESS: 45yo woman with history of headaches for at least the past 10
years. She states that she sometimes wakes up with them and
sometimes they come on over the course of the day. She takes
tylenol with moderate relief. She attributed the headaches to
stress, but underwent a CT 3 yrs ago which was reportedly
negative. Since the H/A's continued she requested an MRI which
revealed a right frontal dural based contrast enhancing mass.

MEDICAL HISTORY: PMHx: C-section, laparoscopy

MEDICATION ON ADMISSION: tylenol

ALLERGIES: CT contrast

PHYSICAL EXAM: Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs intact
Neck: Supple.
Lungs: no adventicious sounds
Cardiac: RRR
Abd: Soft, NT
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-18**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: nc

SOCIAL HISTORY: has 7year old twins. cares for 87yr old mother. [**Name (NI) **] degree,
works as a residential counsler for mentally challenged
children. No T/E/D abuse 

### Response:
{'Benign neoplasm of cerebral meninges,Cerebral edema'}
