CHIEF COMPLAINT: headache past ten days

PRESENT ILLNESS: Mr. [**Known lastname **] [**Known lastname **] is a 57 y/o male who was in good health until
10 days ago, when he began having gradually worsening headaches.
These were right-sided and throbbing and initially controlled
with over the counter analgesics, but are now refractory to
these.  He has had no visual changes in association, no N/V or
drowsiness. He does not appreciate worsening with cough/strain
or
sneezing.  The patient denies other difficulties, such as
weakness, numbness/tingling, visual loss or diplopia, speech
abnormalities, gait difficulties, vertigo, dysarthria or
dysphagia. He was taken to an outside hospital today, where head
CT revealed an intracranial mass lesion. He was given decadron
and sent to [**Hospital1 18**] ER.

MEDICAL HISTORY: renal cell carcinoma s/p L nephrectomy in [**2129**], no xrt/chemo

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 97.9 60 150/100 12 97%
Gen Awake, cooperative, NAD
HEENT NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck Supple, no carotid bruits appreciated. No nuchal rigidity
Lungs CTA bilaterally
CV RRR, nl S1S2, no M/R/G noted
Abd soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted
Ext No C/C/E b/l
Skin no rashes or lesions noted

FAMILY HISTORY: negative for past malignancies

SOCIAL HISTORY: lives with his daughter. Infrequent EtOH use. Quit smoking
25yrs ago. No IVDU
Secondary malignant neoplasm of brain and spinal cord,Compression of brain,Secondary malignant neoplasm of lung,Personal history of malignant neoplasm of kidney
Sec mal neo brain/spine,Compression of brain,Secondary malig neo lung,Hx of kidney malignancy
Admission Date:  [**2138-4-7**]              Discharge Date:   [**2138-4-16**]

Date of Birth:  [**2080-9-7**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
headache past ten days


Major Surgical or Invasive Procedure:
Image guided right craniotomy for tumor resection

History of Present Illness:
Mr. [**Known lastname **] [**Known lastname **] is a 57 y/o male who was in good health until
10 days ago, when he began having gradually worsening headaches.
These were right-sided and throbbing and initially controlled
with over the counter analgesics, but are now refractory to
these.  He has had no visual changes in association, no N/V or
drowsiness. He does not appreciate worsening with cough/strain
or
sneezing.  The patient denies other difficulties, such as
weakness, numbness/tingling, visual loss or diplopia, speech
abnormalities, gait difficulties, vertigo, dysarthria or
dysphagia. He was taken to an outside hospital today, where head
CT revealed an intracranial mass lesion. He was given decadron
and sent to [**Hospital1 18**] ER.


Past Medical History:
renal cell carcinoma s/p L nephrectomy in [**2129**], no xrt/chemo


Social History:
lives with his daughter. Infrequent EtOH use. Quit smoking
25yrs ago. No IVDU

Family History:
negative for past malignancies


Physical Exam:
VS 97.9 60 150/100 12 97%
Gen Awake, cooperative, NAD
HEENT NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck Supple, no carotid bruits appreciated. No nuchal rigidity
Lungs CTA bilaterally
CV RRR, nl S1S2, no M/R/G noted
Abd soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted
Ext No C/C/E b/l
Skin no rashes or lesions noted

NEURO EXAM
MS Awake, alert and oriented x 3.  Speech fluent, with normal
naming, [**Location (un) 1131**], comprehension and repetition. Able to follow
both midline and appendicular commands. No apraxia. No
dysarthria.

CN I: not tested
CN II: Visual fields were full to confrontation, but with
extinction on the left to double simultaneous stimulation.
Pupils
4->2 b/l.
CN III, IV, VI: EOMI no nystagmus or diplopia
CN V: intact to LT throughout;
CN VII: slight L NLF flattening and asymmetry
CN VIII: hearing intact to FR b/l
CN IX, X: palate rises symmetrically
CN [**Doctor First Name 81**]: shrug [**4-28**] and symmetric
CN XII: tongue midline and agile

Motor
Normal bulk and tone. No pronator drift
  D B T WE FE FF IP Q H DF PF TE
L 5 5 5 5  5- 5  5  5 5 5  5  5

Sensory intact to light touch, pinprick, joint position sense,
vibration throughout. No extinction to double simultaneous
stimulation.

Reflexes
   Br  [**Hospital1 **]  Tri  Pat  Ach  Toes
L  2   2   2    2    1    down
R  2   2   2    2    1    down

Coordination Fine finger movements, rapid alternating movements,
finger-to-nose, and heel-to-shin were all normal

Pertinent Results:
[**2138-4-7**] 04:30PM   PT-12.6 PTT-26.8 INR(PT)-1.1
[**2138-4-7**] 04:30PM   PLT COUNT-156
[**2138-4-7**] 04:30PM   NEUTS-87.7* LYMPHS-10.9* MONOS-1.0* EOS-0.3
BASOS-0.1
[**2138-4-7**] 04:30PM   WBC-6.7 RBC-5.41 HGB-15.8 HCT-47.0 MCV-87
MCH-29.2 MCHC-33.7 RDW-13.2
[**2138-4-7**] 04:30PM   estGFR-Using this
[**2138-4-7**] 04:30PM   GLUCOSE-107* UREA N-19 CREAT-1.4* SODIUM-140
POTASSIUM-4.4 CHLORIDE-106 TOTAL CO2-25 ANION GAP-13

MR HEAD W & W/O CONTRAST  [**2138-4-8**] 5:37 AM

MR HEAD W & W/O CONTRAST

Reason: evaluate lesion
Contrast: MAGNEVIST

[**Hospital 93**] MEDICAL CONDITION:
57 year old man with intracranial mass lesion
REASON FOR THIS EXAMINATION:
evaluate lesion
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 57-year-old mid patient, with endocranial mass
lesion, to evaluate lesion.

PRIOR STUDIES: CT of the head done on [**2138-4-7**].

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

FINDINGS:

There is a large heterogeneous mass lesion, in the right
temporoparietal lobes, with areas of hemorrhage, cystic change,
necrosis and large solid enhancing component. The solid
competent measures 5.0 x 4.3 cm. There is entrapment of the
right temporal [**Doctor Last Name 534**]. There is surrounding significant vasogenic
edema, with a leftward shift of subfalcine herniation; measuring
approximately 1 cm is unchanged, allowing for technical
differences, compared to the prior CT. Mass effect on the right
lateral ventricle, is unchanged. There is a 1.7 x 1.6 cm round
focus of increased signal on the FLAIR, with enhancement on the
post-contrast images in the left parapharyngeal space, which
corresponds to an abnormally enlarged lymph node, on correlation
with the CT angiogram performed on the same day (series 9, image
1), however, this is not completely included on our present
study.

IMPRESSION:
1. Large heterogeneous mass lesion in the right parietal and
temporal lobes, with cystic, necrotic, hemorrhagic and solid
components, the solid competent measuring 5.0 cm, with
significant surrounding edema, mass effect and subfalcine
herniation, and entrapment of the right temporal [**Doctor Last Name 534**] without
significant change since the CT head done the day before.

2. 1.7-cm enhancing focus in the left parapharyngeal region,
representing an abnormally enlarged lymph node, representing
metastatic involvement. However, this is not completely included
on our present study.
MR HEAD W & W/O CONTRAST  [**2138-4-13**] 2:41 PM

MR HEAD W & W/O CONTRAST

Reason: residual mass?
Contrast: MAGNEVIST

[**Hospital 93**] MEDICAL CONDITION:
57 year old man with parietal mass s/p resection
REASON FOR THIS EXAMINATION:
residual mass?
CONTRAINDICATIONS for IV CONTRAST: None.

GADOLINIUM-ENHANCED MR SCAN OF THE BRAIN

HISTORY: Status post resection of right parietal mass. Assess
for residual tumor.

TECHNIQUE: Multiplanar T1- and T2-weighted brain imaging was
obtained pre- and post-gadolinium administration.

COMPARISON STUDY: MR scan of the brain from [**2138-4-8**].

FINDINGS: There is a lace-like pattern of enhancement along the
anteromedial aspect of the right temporal lobe, apparently
surrounding the right temporal [**Doctor Last Name 534**] body. There is persistent
mild dilatation of the right temporal [**Doctor Last Name 534**] tip, but
substantially reduced in extent compared to the prior
preoperative study. Additionally, there is presumed hemorrhage
along the operative tract, more peripherally situated within the
posterior aspect of the right temporal lobe.

The extensive edema surrounding the formerly very large tumor
appears unaltered in extent. However, overall, there is somewhat
less mass effect, though there is still leftward subfalcine
herniation present. Numerous tiny areas of elevated T2 signal
are seen within the white matter of both cerebral hemispheres,
presumably representing chronic small vessel infarctions or
post- inflammatory residua.

There is soft tissue swelling, subgaleal in locale at the
craniotomy site and there is a possible fluid collection or
surgical material within the crescent- shaped space between the
dura spanning the craniotomy flap and the inner table of the
flap itself.

There is redemonstration of the well- defined, rounded 21 mm
area of contrast enhancement in the left parapharyngeal fat
area. Its sharp margination seems most consistent with a benign
neoplastic process (question neurogenic tumor). This location
would be very unusual for a lymph node or metastatic disease, as
was suggested on the previous report.

CONCLUSION: Findings suggest that there is residual tumor in the
region of the right temporal lobe surrounding the right temporal
[**Doctor Last Name 534**], with mild residual entrapment of this portion of the right
lateral ventricle, as described above.

Pathology pending at time of discharge

Brief Hospital Course:
The patient was admitted to the neurosurgery service with an
intraventricular mass in the ICU for close monitoring. He was
started on Decadron and dilantin. An [**Doctor Last Name 4338**] was obtained to further
characterize the lesion. A staging CT of the torso was obtained
which showed metastasis to the lungs, left hilum, and spine. He
was hydrated with bicarb fluids and given Mucomyst for renal
protection prior to the CT scans. On HD#2 he was transferred to
the neuro step down unit. A WAND study was obtained for image
guidance of the resection. He was taken to the OR for resection
of the brain mass on HD#5.  He tolerated the procedure well and
initially recovered in the PACU.  He was extubated in the PACU
without difficulty.  He was then transferred to the neurosurgery
step down unit. On POD#1 a repeat [**Doctor Last Name 4338**] was obtained which showed
no bleeding.  He was then transferred to the floor. On POD#2 his
diet was advanced, his Foley was removed and he was seen by
PT/OT. His Decadron was weaned to 2 mg TID.  He was seen by
oncology and radiation oncology who recommended follow up in the
brain tumor clinic and the biologics clinic.  These appointments
were set up for the patient.  His antibiotics were stopped on
POD#4. On POD#5 he was tolerating a regular diet, he had had a
bowel movement, he was voiding without difficulty and he was
cleared by PT for home.  He was discharged home with follow up
instructions.

Medications on Admission:
None

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain or fever.
2. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day).
Disp:*30 Tablet(s)* Refills:*0*
3. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
Disp:*90 Capsule(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
5. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO tid ().
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Brain tumor

Discharge Condition:
Stable

Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR CRANIOTOMY/HEAD INJURY

??????	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:
PLEASE RETURN TO THE OFFICE IN [**5-3**] DAYS FOR REMOVAL OF YOUR
STAPLES/SUTURES CALL [**Telephone/Fax (1) **] to schedule an appointment

PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH
DR.[**Last Name (STitle) **] TO BE SEEN IN 4 WEEKS.

Additional appointments:

Provider: [**Name10 (NameIs) 4338**] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2138-5-2**] 2:35
Provider: [**Name10 (NameIs) 5005**] [**Last Name (NamePattern4) 5342**], MD Phone:[**Telephone/Fax (1) 44**]
Date/Time:[**2138-5-5**] 4:00
[**Hospital 29684**] Clinic on [**2138-4-23**] at 3PM. They will send you a letter
with instructions
{'Secondary malignant neoplasm of brain and spinal cord,Compression of brain,Secondary malignant neoplasm of lung,Personal history of malignant neoplasm of kidney'}


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: headache past ten days

PRESENT ILLNESS: Mr. [**Known lastname **] [**Known lastname **] is a 57 y/o male who was in good health until
10 days ago, when he began having gradually worsening headaches.
These were right-sided and throbbing and initially controlled
with over the counter analgesics, but are now refractory to
these.  He has had no visual changes in association, no N/V or
drowsiness. He does not appreciate worsening with cough/strain
or
sneezing.  The patient denies other difficulties, such as
weakness, numbness/tingling, visual loss or diplopia, speech
abnormalities, gait difficulties, vertigo, dysarthria or
dysphagia. He was taken to an outside hospital today, where head
CT revealed an intracranial mass lesion. He was given decadron
and sent to [**Hospital1 18**] ER.

MEDICAL HISTORY: renal cell carcinoma s/p L nephrectomy in [**2129**], no xrt/chemo

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 97.9 60 150/100 12 97%
Gen Awake, cooperative, NAD
HEENT NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck Supple, no carotid bruits appreciated. No nuchal rigidity
Lungs CTA bilaterally
CV RRR, nl S1S2, no M/R/G noted
Abd soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted
Ext No C/C/E b/l
Skin no rashes or lesions noted

FAMILY HISTORY: negative for past malignancies

SOCIAL HISTORY: lives with his daughter. Infrequent EtOH use. Quit smoking
25yrs ago. No IVDU 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Compression of brain,Secondary malignant neoplasm of lung,Personal history of malignant neoplasm of kidney'}
