CHIEF COMPLAINT: ICH

PRESENT ILLNESS: 51 RHW with PMH of migraines transferred from OSH for eval of
ICH. Patient states that she had sudden onset HA last night
around 6pm. It was dull to start but later was throbbing and
pulsating. It was on the left region her skull. The HA reached
its severity in next few mins. She took 7 OTC advil and went to
sleep.  Patient did not notice any neurologic changes.  Upon
wakening, her husband noted she had a R sided facial droop and
was having difficulty word finding. They then went into an OSH
for further evaluation.

MEDICAL HISTORY: Migraines

MEDICATION ON ADMISSION: MVI
iron

ALLERGIES: Magnevist

PHYSICAL EXAM: T- 137/70, 80, 16, 98, 99 RA
Gen: Lying in bed, NAD,
HEENT: NC/AT, moist oral mucosa
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
Abd: +BS soft, nontender
Ext: No edema

FAMILY HISTORY: Stroke in grandmother

SOCIAL HISTORY: School teacher. lives with husband
[**Name (NI) **] smoking/alcohol/drugs
Malignant neoplasm of temporal lobe,Intracerebral hemorrhage,Cerebral edema,Cerebral artery occlusion, unspecified with cerebral infarction,Hemiplegia, unspecified, affecting dominant side,Aphasia,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Facial weakness
Mal neo temporal lobe,Intracerebral hemorrhage,Cerebral edema,Crbl art ocl NOS w infrc,Unsp hemiplga domnt side,Aphasia,Part epil w/o intr epil,Migrne unsp wo ntrc mgrn,Facial weakness
Admission Date:  [**2170-8-26**]              Discharge Date:   [**2170-9-5**]

Date of Birth:  [**2118-11-26**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Magnevist

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


Major Surgical or Invasive Procedure:
L craniotomy and partial temporal lobectomy for mass.


History of Present Illness:
51 RHW with PMH of migraines transferred from OSH for eval of
ICH. Patient states that she had sudden onset HA last night
around 6pm. It was dull to start but later was throbbing and
pulsating. It was on the left region her skull. The HA reached
its severity in next few mins. She took 7 OTC advil and went to
sleep.  Patient did not notice any neurologic changes.  Upon
wakening, her husband noted she had a R sided facial droop and
was having difficulty word finding. They then went into an OSH
for further evaluation.

Patient had noticed that since beginning her new job, over the
past month, she had intermittent episodes of strong odors
followed by word finding difficulties that lasted about 15
minutes.  She stated she was having about one every 3 days over
the past month.  However over the past week they have been
daily.


Past Medical History:
Migraines


Social History:
School teacher. lives with husband
[**Name (NI) **] smoking/alcohol/drugs



Family History:
Stroke in grandmother



Physical Exam:
T- 137/70, 80, 16, 98, 99 RA
Gen: Lying in bed, NAD,
HEENT: NC/AT, moist oral mucosa
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
Abd: +BS soft, nontender
Ext: No edema

NEUROLOGIC EXAM:

Mental Status:
General: Alert, awake, normal affect
Orientation: X3
Attention: count back from 20.
Executive function: follows command
Speech/Language: Fluent with many paraphasic errors;
comprehension appears intact. difficulty with low frequency
objects.

Cranial Nerves:
II: Pupils equally round and reactive to light, 3->2  mm
bilaterally; visual fields full
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus
V1-3: Sensation intact V1-V3 touch and pain.
VII: has decreased facial movements and droop on R side.
VIII: Hearing intact to finger rub bilaterally
IX & X: Palate elevation symmetric; uvula is midline
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius full strength bilaterally
XII: Good bulk, no fasciculations; tongue midline, movements
intact

Motor:
R sided pronator drift
      D  B T Wr Grip
Left  5  5 5 5  5
Right 5  5 5 5  5
       IP Q  H  DF PF [**Last Name (un) 938**]
Left   5  5  5  5  5  5
Right  5  5  5  5  5  5

Deep Tendon Reflexes:
            B  Tr Br  Pt [**Name (NI) 42691**]
[**Name (NI) 167**]       2  2  2   2  2
Left        2  2  2   2  2

Sensation: Intact to light touch, vibration, and temperature
throughout

Coordination: Finger-nose-finger normal bilaterally

On Discharge:
Expressive aphasia
A&Ox3 with prompting
EOMs intact
L ptosis
R facial droop
Motor:
       D B T IP [**Initials (NamePattern5) 12643**] [**Last Name (NamePattern5) **] AT [**Last Name (un) 938**]
     R 0 0 0 5- [**4-24**]- 0   0   0
     L 5 5 5 5  5 5  5   5   5
Incision: c/d/i staples in place



Pertinent Results:
CTA HEAD and NeckW&W/O C & RECONS [**2170-8-26**]
1. Unchanged appearance of the large left temporal hematoma with

intraventricular extention and associated mass effect, as
described above.
2. Normal neck CTA. The left vertebral artery arises directly
from the
aortic arch, a normal variant.
3. The left middle cerebral artery is displaced superiorly due
to the mass
effect from the left temporal hematoma. There is no evidence of
intracranial arterial aneurysm or arteriovenous malformation.
Since a small vascular malformation could be compressed by the
hematoma, follow-up MRA should be considered when blood products
resolved, if no other source of hemorrhage is identified.

MR HEAD W & W/O CONTRAST [**2170-8-26**]
Expected appearance of the large acute hematoma centered in the

inferomedial aspect of the left temporal lobe with
intraventricular extension, mass effect and slight uncal
herniation, stable.
  However, the pattern of enhancement, which is relatively thick
and eccentric to the locus of hemorrhage, is atypical; while
this may reflect neovascularity related to the organizing
hematoma, it raises concern regarding an underlying hemorrhagic
mass lesion (is there history or other evidence of primary
neoplasm?). There is no pathologic focus of enhancement
elsewhere

[**8-29**] MRI Head: IMPRESSION: Unchanged appearance of the irregular
rim-enhancing mass in the left temporal lobe most likely
consistent with a primary brain tumor such as glioblastoma.
Other findings as described above. The examination performed for
pre-operative planning.

[**8-30**] CT head: IMPRESSION: Expected post-surgical appearance after
left frontotemporal craniotomy and temporal lobe resection,
without change in the previously-seen 3-4 mm shift of midline
structures and minimal left uncal herniation.

[**8-31**] MRI head: IMPRESSION: 1. Recent resection of left temporal
lobe tumor. Residual nodular enhancement along the lateral
operative bed is suspicious for residual tumor. 2. Small acute
infarct of the lateral thalamus, hippocampus and adjacent
posterior limb of internal capsule.


Brief Hospital Course:
51 y/o F presented with headache to OSH. Head CT showed L
parietal IPH. She was transferred to [**Hospital1 18**] for further
evaluation. She was admitted to the neurological service and MRI
head was done. MRI showed underlying mass. Patient presented
with expressive aphasia, slight R facial droop and L ptosis with
full strength. She was transferred to the neurosurgical service
on [**8-28**] and will go to the OR for resection on [**8-29**].

Pt underwent left sided craniotomy on [**8-29**] without complication.
Post operatively she was extubated and transfered to the ICU for
strict blood pressure control less than 140 systolic and q1
neuro checks. Frozen section sent from the OR was consistent
with high grade glioma. She was continued on decadron 4mg q6 and
keppra for seizure prophylaxis. On post op exam she was awake
and alert with eyes open and following commands on her left
side. She was noted to have dense R hemiplegia on exam and
complete expressive aphasia, her R facial droop remained.

On [**8-30**] Pt seen on A.M rounds and had no change from her post
operative exam. She remained with her R hemiplegia and
expressive aphasia. She remained in the ICU for continued blood
pressure control and q1 neurochecks. 24 hour EEG monitoring was
obtained to evaluate for seizure activity. The neuro-oncology
team was consulted for further recommendations regarding her
care and follow up. Occupational therapy was consulted for her
aphasia as was the speech therapist.

On [**8-31**] patient remained stable, EEG monitoring continued.
Routine post op MRI was performed revealing small left infarct
and residual tumor.
On [**9-1**] EEG and a-line were discontinued and she was cleared for
transfer to the stepdown unit. surgical dressing was removed.

On [**9-2**] she was again stable and cleared for transfer to the
floor. She continued on decadron 4mg q6hrs secondary to
persistant aphasia.

On [**9-3**], patient's aphasia slightly improved, decadron was
tapered. Her exam continues to improve with RLE [**2-23**], full
strength on L and 0/5 in RUE. She will continue to work with
PT/OT/speech.

He met with the Brain [**Hospital 341**] Clinic team on [**9-4**].  PT saw the
patient and recommended rehab for PT/OT/speech. After meeting
with Dr. [**Last Name (STitle) 6570**], it was decided that they would have
chemo/radiation therapy in MA. She was discharged to [**Hospital1 **] in [**Hospital1 8**].


Medications on Admission:
MVI
iron


Discharge Medications:
1. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for c.
3. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
4. Glucagon (Human Recombinant) 1 mg Recon Soln Sig: One (1)
Recon Soln Injection Q15MIN () as needed for hypoglycemia
protocol.
5. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
6. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
7. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
8. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
9. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol
11. Fosphenytoin 100 mg PE IV BID seizure
12. Sodium Chloride 0.9%  Flush 3 mL IV Q8H:PRN line flush
Peripheral line: Flush with 3 mL Normal Saline every 8 hours and
PRN.
13. Dexamethasone 2 mg  IV BID Duration: 1 Days Start: After 2
mg  tapered dose.
14. HydrALAzine 10-20 mg IV Q6H:PRN SBP<140


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital - [**Hospital1 8**]

Discharge Diagnosis:
L parietal Mass


Discharge Condition:
Neurologically stable


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 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**].

??????	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 [**6-30**] days ([**2170-9-8**]) for removal
of your staples. This can be done at the rehab facility
??????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.
??????       You are scheduled for a Brain Tumor Clinc appointment on
[**9-7**] at 1 pm with Dr. [**Last Name (STitle) 6570**] on [**Hospital Ward Name 23**] 8. Please call
[**Telephone/Fax (1) 1844**] with further questions.



Completed by:[**2170-9-5**]
{'Malignant neoplasm of temporal lobe,Intracerebral hemorrhage,Cerebral edema,Cerebral artery occlusion, unspecified with cerebral infarction,Hemiplegia, unspecified, affecting dominant side,Aphasia,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Facial weakness'}


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: ICH

PRESENT ILLNESS: 51 RHW with PMH of migraines transferred from OSH for eval of
ICH. Patient states that she had sudden onset HA last night
around 6pm. It was dull to start but later was throbbing and
pulsating. It was on the left region her skull. The HA reached
its severity in next few mins. She took 7 OTC advil and went to
sleep.  Patient did not notice any neurologic changes.  Upon
wakening, her husband noted she had a R sided facial droop and
was having difficulty word finding. They then went into an OSH
for further evaluation.

MEDICAL HISTORY: Migraines

MEDICATION ON ADMISSION: MVI
iron

ALLERGIES: Magnevist

PHYSICAL EXAM: T- 137/70, 80, 16, 98, 99 RA
Gen: Lying in bed, NAD,
HEENT: NC/AT, moist oral mucosa
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
Abd: +BS soft, nontender
Ext: No edema

FAMILY HISTORY: Stroke in grandmother

SOCIAL HISTORY: School teacher. lives with husband
[**Name (NI) **] smoking/alcohol/drugs 

### Response:
{'Malignant neoplasm of temporal lobe,Intracerebral hemorrhage,Cerebral edema,Cerebral artery occlusion, unspecified with cerebral infarction,Hemiplegia, unspecified, affecting dominant side,Aphasia,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Facial weakness'}
