CHIEF COMPLAINT: Seizure

PRESENT ILLNESS: This is a 44 year old AAF who was originally seen in the ED. She
reports that she was sleeping and she had a seizure which was
witnessed by her husband.  [**Name (NI) **] husband said it lasted about 2
minutes.  It entailed her full body shaking / eyes rolled back /
severe neck spasms.   He called EMS and she was brought to
[**Hospital3 **]. Imaging revealed right frontal mass with edema.
 She was then transferred to [**Hospital1 18**].  She has already received
Decadron 10mg and Dilantin 1gm IV load.  She admited to two
weeks of headaches and generalized weakness, memory issues as
well as some dizziness.  She denies falls / LOC / visual
changes / nausea / vomiting / speech difficulties or
incontinence.

MEDICAL HISTORY: HTN

MEDICATION ON ADMISSION: HCTZ

ALLERGIES: Erythromycin Base

PHYSICAL EXAM: On Admission:
O: T: 99.6      125/96  HR  85    R  20     O2Sats100%
Gen: WD/WN, comfortable, NAD. normal affect
HEENT: NCAT Pupils:[**3-23**] bilaterally and brisk          EOMI
Neck: Supple.
Extrem: Warm and well-perfused.
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.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives with husband and 10 yr old son / also has a 25 yr old
daughter who is not in the home/ she works as a manager for a
furniture store / she smokes about 2 cigarettes a day / drinks
rarely and does not use any drugs
Benign neoplasm of cerebral meninges,Compression of brain,Other convulsions,Unspecified essential hypertension
Ben neo cerebr meninges,Compression of brain,Convulsions NEC,Hypertension NOS
Name:  [**Known lastname **],[**Known firstname **]                     Unit No:   [**Numeric Identifier 15832**]

Admission Date:  [**2198-12-31**]              Discharge Date:   [**2199-1-7**]

Date of Birth:  [**2154-1-29**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Erythromycin Base

Attending:[**First Name3 (LF) 599**]
Addendum:
This addendum is to clarify that prior to surgery the patient
had significant edema and brain compression which were improved
following surgical intervention

Discharge Disposition:
Home

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 603**] MD [**MD Number(2) 604**]

Completed by:[**2199-2-5**]

Admission Date:  [**2198-12-31**]              Discharge Date:   [**2199-1-7**]

Date of Birth:  [**2154-1-29**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Erythromycin Base

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

Major Surgical or Invasive Procedure:
[**1-3**] Right Frontal Craniotomy for Mass Resection


History of Present Illness:
This is a 44 year old AAF who was originally seen in the ED. She
reports that she was sleeping and she had a seizure which was
witnessed by her husband.  [**Name (NI) **] husband said it lasted about 2
minutes.  It entailed her full body shaking / eyes rolled back /
severe neck spasms.   He called EMS and she was brought to
[**Hospital3 **]. Imaging revealed right frontal mass with edema.
 She was then transferred to [**Hospital1 18**].  She has already received
Decadron 10mg and Dilantin 1gm IV load.  She admited to two
weeks of headaches and generalized weakness, memory issues as
well as some dizziness.  She denies falls / LOC / visual
changes / nausea / vomiting / speech difficulties or
incontinence.

Past Medical History:
HTN


Social History:
Lives with husband and 10 yr old son / also has a 25 yr old
daughter who is not in the home/ she works as a manager for a
furniture store / she smokes about 2 cigarettes a day / drinks
rarely and does not use any drugs

Family History:
Unknown

Physical Exam:
On Admission:
O: T: 99.6      125/96  HR  85    R  20     O2Sats100%
Gen: WD/WN, comfortable, NAD. normal affect
HEENT: NCAT Pupils:[**3-23**] bilaterally and brisk          EOMI
Neck: Supple.
Extrem: Warm and well-perfused.
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, 4 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 [**4-25**] throughout. No pronator drift

Sensation: Intact to light touch.
No clonus

On Discharge: neuro intact, mild short term memory issues which
are improving

Pertinent Results:
ADMISSION LABS:

[**2198-12-31**] 10:35AM   PT-13.1 PTT-25.3 INR(PT)-1.1
[**2198-12-31**] 10:35AM   WBC-10.1 RBC-4.94 HGB-14.3 HCT-42.3 MCV-86
MCH-28.9 MCHC-33.8 RDW-14.0
[**2198-12-31**] 10:35AM   GLUCOSE-112* UREA N-6 CREAT-0.7 SODIUM-140
POTASSIUM-3.3 CHLORIDE-98 TOTAL CO2-26 ANION GAP-19

IMAGING:
MRI Head [**12-31**]:
2.3 (TRV) X 2.9 (CC) X 2.8 (AP) CM (101:46, 100:89) T1-ISO,
T2-HYPER/ISO TO [**Doctor Last Name **] MATTER, ENHANCING PARASAGITTAL RT FRONTAL
EXTRAAXIAL MASS WITH MILD EDEMA IN UNDERLYING RT FRONTAL LOBE.
ADJACENT SULCAL EFFACEMENT, MILD
LEFTWARD MASS EFFECT ON FALX & MASS EXTENDS UP TO 5-MM TO LEFT
OF MIDLINE.
PUNCTATE LOW SIGNAL WITHIN MASS ?CALC (REC [**Last Name (un) **] WITH PRIOR CT).
MOST LIKELY MENINGIOMA.

[**1-3**] HEAD CT:
Expected postoperative changes. No evidence of significant
intraparenchymal hemorrhage

[**1-4**] HEAD MRI:
Expected postoperative change following resection of right
frontal extra-axial mass with no large infarction or hemorrhage.



Brief Hospital Course:
The patient was admitted to the Neurosurgery Service for further
evaluation and work up of the known brain mass.  She was loaded
with Dilantin and decadron, and underwent an MRI.  This
demonstrated a right sided frontal extra-axial parasagittal mass
c/w meningioma. She was stable on the floor overnight from [**12-31**]
to [**1-1**] and was scheduled to go to the OR on [**1-3**] for resection
of the lesion and a pre-op workup was initiated.
On [**1-3**] she was taken to the OR and underwent crani & mass
resection. Surgery was without complication and she tolerated it
well. She was extubated and transferred to the ICU. Post op head
CT was stable without hemorrhage.
On [**1-4**] patient was neurologically intact. She complained of
headache which was treated with IV and PO meds. She was
ambulating & tolerating a PO diet. At this time she was cleared
for transfer to the floor and written for a decadron taper. MRI
showed expected post-op changes. She remained neurologically
intact on the floor and was ambulatory with PT.  PT cleared her
for home without services and she spoke with social work
regarding concerns she had.  She was deemed fit for discharge
and was discharged to home on [**2199-1-7**] with instructions for
follow-up

Medications on Admission:
HCTZ

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. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain fever: ax 4g/day.
6. butalbital-acetaminophen-caff 50-325-40 mg Tablet Sig: [**12-23**]
Tablets PO Q6H (every 6 hours) as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*
7. phenytoin sodium extended 100 mg Capsule Sig: Two (2) Capsule
PO BID (2 times a day).
Disp:*90 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Seizure
right Frontal Mass


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


Discharge Instructions:
General Instructions/Information

??????	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.
??????	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 are being sent home on steroid medication, make sure
you are taking a medication to protect your stomach (Prilosec,
Protonix, or Pepcid), as these medications can cause stomach
irritation.  Make sure to take your steroid medication with
meals, or a glass of milk.
??????	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.
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: increasing redness,
increased swelling, increased tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
Follow-Up Appointment Instructions

??????Your sutures will need to be removed in [**6-30**] days. Please call
our office to make an appointment for this. Our office phone
number is [**Telephone/Fax (1) 1669**]
??????Please call to make an appointment with Dr [**Last Name (STitle) **] in 4 weeks.
Our office number is [**Telephone/Fax (1) 1669**]. You will need a CT scan of
the head



Completed by:[**2199-1-7**]
{'Benign neoplasm of cerebral meninges,Compression of brain,Other convulsions,Unspecified essential hypertension'}


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: Seizure

PRESENT ILLNESS: This is a 44 year old AAF who was originally seen in the ED. She
reports that she was sleeping and she had a seizure which was
witnessed by her husband.  [**Name (NI) **] husband said it lasted about 2
minutes.  It entailed her full body shaking / eyes rolled back /
severe neck spasms.   He called EMS and she was brought to
[**Hospital3 **]. Imaging revealed right frontal mass with edema.
 She was then transferred to [**Hospital1 18**].  She has already received
Decadron 10mg and Dilantin 1gm IV load.  She admited to two
weeks of headaches and generalized weakness, memory issues as
well as some dizziness.  She denies falls / LOC / visual
changes / nausea / vomiting / speech difficulties or
incontinence.

MEDICAL HISTORY: HTN

MEDICATION ON ADMISSION: HCTZ

ALLERGIES: Erythromycin Base

PHYSICAL EXAM: On Admission:
O: T: 99.6      125/96  HR  85    R  20     O2Sats100%
Gen: WD/WN, comfortable, NAD. normal affect
HEENT: NCAT Pupils:[**3-23**] bilaterally and brisk          EOMI
Neck: Supple.
Extrem: Warm and well-perfused.
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.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives with husband and 10 yr old son / also has a 25 yr old
daughter who is not in the home/ she works as a manager for a
furniture store / she smokes about 2 cigarettes a day / drinks
rarely and does not use any drugs 

### Response:
{'Benign neoplasm of cerebral meninges,Compression of brain,Other convulsions,Unspecified essential hypertension'}
