CHIEF COMPLAINT: progressive Right sided hearing loss, right sided tinnitus

PRESENT ILLNESS: Patient presents to clinic in referral from Dr [**Last Name (STitle) **] in
neurology. Patient complains of tinnitus in her rigth ear x 10
years which she can trace back to an event where she heard a
loud
popping sound. She also complains of recent progressive right
sided hearing loss which on formal audiogram testing confirms as
severe. She also reports that she has balance issues and
difficutly with short term memory. MRI was obtained prior to the
visit and shows a right sided CP angle lesion. She denies
headaches, nausea, vomiting, dizziness, blurry vision, or
difficulty hearing with her left ear.
She presents for elective resection of CPA tumor.

MEDICAL HISTORY: Appendicitis, ectopic pregnancy

MEDICATION ON ADMISSION: buspar (unknown dose), naproxen (held 10 days prior to surgery),
percocet PRN

ALLERGIES: Aspirin

PHYSICAL EXAM: On Admission:
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL     EOMs full without nystagmus
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: Denies family history of brain tumor

SOCIAL HISTORY: Works as a CNA
Benign neoplasm of cranial nerves,Other nervous system complications,Injury to facial nerve,Tinnitus, unspecified,Sensorineural hearing loss, unilateral,Other acute postoperative pain,Vestibular neuronitis,Arthropathy, unspecified, site unspecified,Personal history of peptic ulcer disease,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Benign neo cranial nerve,Surg comp nerv systm NEC,Injury to facial nerve,Tinnitus NOS,Sensorneur hear loss uni,Acute postop pain NEC,Vestibular neuronitis,Arthropathy NOS-unspec,Prsnl hst peptic ulcr ds,Abn react-surg proc NEC
Admission Date:  [**2189-6-24**]              Discharge Date:   [**2189-6-29**]

Date of Birth:  [**2130-1-7**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Aspirin

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
progressive Right sided hearing loss, right sided tinnitus

Major Surgical or Invasive Procedure:
Right suboccipital craniotomy for resection of vestibular
schwannoma


History of Present Illness:
Patient presents to clinic in referral from Dr [**Last Name (STitle) **] in
neurology. Patient complains of tinnitus in her rigth ear x 10
years which she can trace back to an event where she heard a
loud
popping sound. She also complains of recent progressive right
sided hearing loss which on formal audiogram testing confirms as
severe. She also reports that she has balance issues and
difficutly with short term memory. MRI was obtained prior to the
visit and shows a right sided CP angle lesion. She denies
headaches, nausea, vomiting, dizziness, blurry vision, or
difficulty hearing with her left ear.
She presents for elective resection of CPA tumor.


Past Medical History:
Appendicitis, ectopic pregnancy


Social History:
Works as a CNA


Family History:
Denies family history of brain tumor

Physical Exam:
On Admission:
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL     EOMs full without nystagmus
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
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,  4mm to
3mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength intact and symmetric.  Slightly
decreased sensation on the upper right face in the V1 and V2
distribution.
VIII: unable to hear out of right ear.
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 [**6-18**] throughout. No pronator drift

Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally.

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, rapid alternating
movements, heel to shin

On Discharge:
CN VII defecit, Right Facial Droop with incomplete lid closure;
House-Brackmann IV-V
Stable decreased sensation in the Right V1-2 distributions.
Other exam stable.

Pertinent Results:
MRI brain [**6-24**] - right cerebellopontine angle mass lesion with
partial
extension into the right internal auditory canal, likely
consistent with a
vestibular schwannoma, meningioma is a more remote
consideration, no new
lesions are identified. Fiducial markers are in place.

CT brain [**6-24**] - Status post right suboccipital craniotomy.
Expected postoperative changes in
the posterior fossa. No postoperative hemorrhage. Extensive
pneumocephalus
is seen tracking throughout the sulci of the bilateral cerebral
convexities

MRI Brain [**6-25**] -
1. Status post resection of a large right cerebellopontine angle
tumor, with a few enhancing nodules, largest measuring 5mm,
within the cistern and in the right internal auditory canal
possibly representing residual tumor. Continued followup to this
region is recommended to assess for residual tumor and diff.
from reactive changes and assess stability. A small focus of
decreased diffusion is of uncertain etiology- ? small infarct/
blood products/tumor. Attention on close follow up with complete
brain MRI study.

2. Post-right suboccipital craniotomy changes, including fluid
within the
right mastoid air cells and post-surgical soft tissue swelling
and edema, all within expected post-procedure limits.


Brief Hospital Course:
Pt underwent elective resection of a right-sided
cerebellopontine angle tumor under general anesthesia with
facial nerve monitoring.  Frozen pathology revealed schwannoma.
Postoperatively she was transferred to the ICU for Q1 hour neuro
checks and systolic blood pressure control less than 140.  She
was started on steroids, dexamethasone 4mg Q6hrs with a plan for
a 1 week taper to off.  Postop CT head showed post operative
changes.  Postoperatively, she had a right facial droop and as a
result she remained on dexamethasone. She remained stable during
her ICU course and was transferred to the floor.

She had headaches, incisional pain, nausea and dizziness but
improved with medications and conservative management.  Her diet
was advanced in routine fashion.  She tolerated advances.  She
was evaluated by PT/OT and speech therapy during her course. She
has CN VIII deficit on the right at baseline and new CN VII
deficit on the right. Plastic surgery consult was called for
patient's inability to close her right eye.  They recommended
nothing to do at this time as the patient was seeing small
improvements daily in lid closure.  They recommend reconsulting
after several weeks if deficit persists.

On [**6-29**] she was started on a dexamethasone taper over 1 week to
off.

At the time of discharge she is tolerating a dysphagia diet,
ambulating with a cane or walker, afebrile with stable vital
signs.


Medications on Admission:
buspar (unknown dose), naproxen (held 10 days prior to surgery),
percocet PRN

Discharge Medications:
1. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for PAin.
2. senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed for Constipation.
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for Pain or fever .
5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
7. cyclobenzaprine 10 mg Tablet Sig: 0.5 Tablet PO TID (3 times
a day) as needed for spasm.
8. white petrolatum-mineral oil 56.8-42.5 % Ointment Sig: One
(1) Appl Ophthalmic HS (at bedtime).
9. polyvinyl alcohol 1.4 % Drops Sig: 1-2 Drops Ophthalmic PRN
(as needed) as needed for dryness: Right eye.
10. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
11. meclizine 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day) as needed for PRN Dizziness.
12. dexamethasone 1 mg Tablet Sig: Two (2) Tablet PO Daily ()
for 2 days: For 2 Days Start: After 2 mg Q 12 hrs tapered dose.
Stop after 2mg daily.
13. dexamethasone 1 mg Tablet Sig: Two (2) Tablet PO 12 hrs ()
for 2 days: Duration: 2 Days Start: After 2 mg Q8 hrs tapered
dose.  Stop after 2mg daily  .
14. dexamethasone 1 mg Tablet Sig: Two (2) Tablet PO 8 hrs ()
for 2 days: Duration: 2 Days Start: After 3 mg Q8hrs tapered
dose.
Stop after 2mg daily .
15. dexamethasone 0.5 mg Tablet Sig: Six (6) Tablet PO 8 hrs ()
for 2 days: Duration: 2 Days Start: After 4 mg tapered dose.
Stop after 2mg daily.
16. dexamethasone 4 mg Tablet Sig: One (1) Tablet PO 8 hrs ()
for 2 days: Duration: 2 Days
Stop after 2mg daily.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Right Vestibular schwannoma
RIGHT CRANIAL NERVE VIII DEFICIT
RIGHT CRANIAL NERVE VII DEFICIT
Right CN V / BRANCHES II AND III DEFICIT
DYSPHAGIA


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
General 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. 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.
??????	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 call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in 4 weeks.
??????You will need an MRI of the brain with contrast



Completed by:[**2189-6-29**]
{'Benign neoplasm of cranial nerves,Other nervous system complications,Injury to facial nerve,Tinnitus, unspecified,Sensorineural hearing loss, unilateral,Other acute postoperative pain,Vestibular neuronitis,Arthropathy, unspecified, site unspecified,Personal history of peptic ulcer disease,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: progressive Right sided hearing loss, right sided tinnitus

PRESENT ILLNESS: Patient presents to clinic in referral from Dr [**Last Name (STitle) **] in
neurology. Patient complains of tinnitus in her rigth ear x 10
years which she can trace back to an event where she heard a
loud
popping sound. She also complains of recent progressive right
sided hearing loss which on formal audiogram testing confirms as
severe. She also reports that she has balance issues and
difficutly with short term memory. MRI was obtained prior to the
visit and shows a right sided CP angle lesion. She denies
headaches, nausea, vomiting, dizziness, blurry vision, or
difficulty hearing with her left ear.
She presents for elective resection of CPA tumor.

MEDICAL HISTORY: Appendicitis, ectopic pregnancy

MEDICATION ON ADMISSION: buspar (unknown dose), naproxen (held 10 days prior to surgery),
percocet PRN

ALLERGIES: Aspirin

PHYSICAL EXAM: On Admission:
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL     EOMs full without nystagmus
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: Denies family history of brain tumor

SOCIAL HISTORY: Works as a CNA 

### Response:
{'Benign neoplasm of cranial nerves,Other nervous system complications,Injury to facial nerve,Tinnitus, unspecified,Sensorineural hearing loss, unilateral,Other acute postoperative pain,Vestibular neuronitis,Arthropathy, unspecified, site unspecified,Personal history of peptic ulcer disease,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
