CHIEF COMPLAINT: Generalized seizure

PRESENT ILLNESS: The patient is a 41 yr old man with known recurrent glioblastoma
multiforme that is managed by a Dr. [**First Name (STitle) **]. He was brought to the
[**Hospital1 **] after he sustained a 3 minute generalized seizure [**Hospital1 14630**]. According to eyewitnesses, the patient became rigid
sitting in his chair watching the baseball game, and was carried
out of his chiar by family and friends. [**Name (NI) 6**] unsuccessful attempt
was made to intubate the patient in the field, when he was
emergently brought to [**Hospital1 **], had a GCS score of 8, and was
emergently intubated. Shortly thereafter, he was loaded with
Dilantin 1 gram and given 12 mg of IV Ativan for "seizure
activity." Upon arrival, I witnessed the patient to be
tremulous, but not actively seizing.
The family was able to tell me that the patient was diagnosed
with glioblastoma multiforme in [**2186-5-2**], and had 70% of the
tumor removed last year with a left frontal lobectomy.  His
presenting symptom which led to the diagnosis of the tumor was a
seizure, and he has had various types of seizures since,
including GTC. His last prolonged seizure lasted about an hour
and he was intubated at [**Hospital3 2576**] [**Hospital3 **] in [**2187-7-3**].
After this seizure, he has been cognitively slower than ever
before. He has been maintained on the current doses of keppra,
zonegran, and steroids for quite some time.

MEDICAL HISTORY: -glioblastoma multiforme as above
-sz disorder
-DVT's
-depression
-gerd

MEDICATION ON ADMISSION: Zonegran 500mg qd
Keppra 2000qAM, 1500mg qPM
Decadron 1mg [**Hospital1 **]
Lovenox 60mg [**Hospital1 **]
Celexa
Iressa
Sirolimus

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:  T-afeb   BP-119/71   HR-95   RR-9
Gen:  lying in bed, intubated sedated
Heent: L frontal craniotomy scar
Neck: supple, no carotid bruits
Chest: clear to auscultation b/l
CV:regular rate, normal s1s2, no m/r/g

FAMILY HISTORY: 

SOCIAL HISTORY: He is a former attorney, lives with his wife and three children.
Malignant neoplasm of frontal lobe,Other convulsions,Esophageal reflux,Depressive disorder, not elsewhere classified,Personal history of venous thrombosis and embolism
Malig neo frontal lobe,Convulsions NEC,Esophageal reflux,Depressive disorder NEC,Hx-ven thrombosis/embols
Admission Date:  [**2187-9-10**]              Discharge Date:   [**2187-9-14**]

Date of Birth:  [**2146-9-8**]             Sex:   M

Service: NMED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Generalized seizure

Major Surgical or Invasive Procedure:
Intubation and mechanical ventilation

History of Present Illness:
The patient is a 41 yr old man with known recurrent glioblastoma
multiforme that is managed by a Dr. [**First Name (STitle) **]. He was brought to the
[**Hospital1 **] after he sustained a 3 minute generalized seizure [**Hospital1 14630**]. According to eyewitnesses, the patient became rigid
sitting in his chair watching the baseball game, and was carried
out of his chiar by family and friends. [**Name (NI) 6**] unsuccessful attempt
was made to intubate the patient in the field, when he was
emergently brought to [**Hospital1 **], had a GCS score of 8, and was
emergently intubated. Shortly thereafter, he was loaded with
Dilantin 1 gram and given 12 mg of IV Ativan for "seizure
activity." Upon arrival, I witnessed the patient to be
tremulous, but not actively seizing.
The family was able to tell me that the patient was diagnosed
with glioblastoma multiforme in [**2186-5-2**], and had 70% of the
tumor removed last year with a left frontal lobectomy.  His
presenting symptom which led to the diagnosis of the tumor was a
seizure, and he has had various types of seizures since,
including GTC. His last prolonged seizure lasted about an hour
and he was intubated at [**Hospital3 2576**] [**Hospital3 **] in [**2187-7-3**].
After this seizure, he has been cognitively slower than ever
before. He has been maintained on the current doses of keppra,
zonegran, and steroids for quite some time.


Past Medical History:
-glioblastoma multiforme as above
-sz disorder
-DVT's
-depression
-gerd


Social History:
He is a former attorney, lives with his wife and three children.

Physical Exam:
PE:  T-afeb   BP-119/71   HR-95   RR-9
Gen:  lying in bed, intubated sedated
Heent: L frontal craniotomy scar
Neck: supple, no carotid bruits
Chest: clear to auscultation b/l
CV:regular rate, normal s1s2, no m/r/g

Neurologic Exam:

MS:
The patient is non-verbal and intubated with sedation.

CN:
Pupils normal round 2.5->2mm with light.
Doll'e eye movements are presnt.
Corneal reflexes are weakly intact.
Gag reflex is intact.
Motor:
With the patient on sedatives and neuromusculal blocking agents
it is difficult to assess tone. Given this, he is globally
hypertonic, especially in the lower extremities. Every 3-5
minutes he will spontaneously extensor posture with 10-15
seconds
tremulous movements across his body.

Reflexes:
There are [**3-7**] reflexes present and symmetric
Plantar reflexes extensor on left, flexor on right.

Sensory:
The patient localizes to painful stimulus with UE, and withdraws
symmetrically in LE.

Coordination:
unable

Gait: cannot assess


Pertinent Results:
[**2187-9-10**] 09:50PM URINE  HOURS-RANDOM
[**2187-9-10**] 09:50PM URINE  GR HOLD-HOLD
[**2187-9-10**] 09:50PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2187-9-10**] 09:50PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.018
[**2187-9-10**] 09:50PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2187-9-10**] 09:50PM URINE  RBC-0 WBC-0 BACTERIA-OCC YEAST-NONE
EPI-<1
[**2187-9-10**] 09:40PM   GLUCOSE-157* UREA N-17 CREAT-1.3* SODIUM-145
POTASSIUM-3.6 CHLORIDE-103 TOTAL CO2-16* ANION GAP-30*
[**2187-9-10**] 09:40PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2187-9-10**] 09:40PM   WBC-8.9 RBC-4.73 HGB-15.1 HCT-43.3 MCV-92
MCH-32.0 MCHC-35.0 RDW-13.5
[**2187-9-10**] 09:40PM   NEUTS-77.1* LYMPHS-17.2* MONOS-5.1 EOS-0.4
BASOS-0.2
[**2187-9-10**] 09:40PM   PLT COUNT-264
[**2187-9-10**] 09:40PM   PT-12.7 PTT-25.2 INR(PT)-1.1

Brief Hospital Course:
In the ER, his GCS was 8 and he was observed to be "shaking".
He was given 12mg of ativan and required intubation and
mechanical ventilation.  He was loaded with dilantin and was
admitted to the NICU.
His CT scan on admission showed:
NONCONTRAST HEAD CT: The study is limited secondary to patient
motion. Allowing for the limitations, there is no gross acute
intracranial hemorrhage. There is a large left frontal mass with
extensive associated edema and areas of calcification in the
region of the rostrum of the corpus callosum. There is
hypodensity in the right frontal lobe, suggestive of the mass
crossing into the right via the corpus callosum. There is
extensive mass effect with flattening of the frontal [**Doctor Last Name 534**] of the
left lateral ventricle. There is likely some degree of mild
subfalcine herniation as well. There is also a focal area of
decreased attenuation in the anterior aspect of the left
temporal lobe, with effacement of the temporal [**Doctor Last Name 534**] of the
lateral ventricle. The differential diagnosis includes extension
of tumor or infarct. Post craniotomy changes are present in the
left frontal region. There is mucosal thickening in the ethmoid
air cells.

He was started on Decadron 4mg IV q8h and maintained on dilantin
100mg tid.  He remained intubated until [**9-11**] when he was
extubated without event. He remained seizure free.  He was
transfered to the floor on [**9-13**].  He was restarted on Sirolimus
on Iressa.  Dilantin was tapered to 100mg [**Hospital1 **] due to drug-drug
interaction which lowers levels of chemotherapeutic agents.  He
will need to be tapered off of dilantin in order to optimize his
chemo treatment. On [**9-14**], he was noted by his sitter to be
"shaking", RN notes indicate a post-ictal confusional state.  It
is unclear if this event was an electric seizure or his baseline
tremulousness.  His Zonegran was increased to 600mg qd.  As per
his family, his mental status and gait are not at baseline.
There is a concern that these new events and worsening of his
functional status are due to progression of his GBM.  There are
no imaging studies at [**Hospital1 18**] for comparison.  His family is
requesting transfer to [**Hospital1 112**] for continued treatment and we have
arranged for transfer to the [**Hospital1 112**] neurology service under the
care of Dr. [**Last Name (STitle) 24642**].

Medications on Admission:
Zonegran 500mg qd
Keppra 2000qAM, 1500mg qPM
Decadron 1mg [**Hospital1 **]
Lovenox 60mg [**Hospital1 **]
Celexa
Iressa
Sirolimus


Discharge Medications:
1. Enoxaparin Sodium 60 mg/0.6mL Syringe Sig: One (1)
Subcutaneous Q12H (every 12 hours).
2. Levetiracetam 500 mg Tablet Sig: Four (4) Tablet PO QAM (once
a day (in the morning)).
3. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO QPM
(once a day (in the evening)).
4. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO QD (once a day).
5. Sirolimus 1 mg/mL Solution Sig: Four (4) mg PO QD (once a
day).
Disp:*16 mg* Refills:*2*
6. IRESSA 250 mg Tablet Sig: Two (2) Tablet PO qd ().
Disp:*60 Tablet(s)* Refills:*2*
7. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours).
8. Zonisamide 100 mg Capsule Sig: Six (6) Capsule PO QD (once a
day).
9. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO BID (2 times a day) for 1 days.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
GBM
Seizure

Discharge Condition:
Stable

Discharge Instructions:
Patient to be transfered to the neurology wervice at [**Hospital1 112**].
Accepting physician:  [**Last Name (NamePattern4) **]. [**Last Name (STitle) 24642**].  Neurology [**Male First Name (un) **] Resident:
Dr. [**Last Name (STitle) **]

Followup Instructions:
Transfer to [**Hospital1 112**]

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]
{'Malignant neoplasm of frontal lobe,Other convulsions,Esophageal reflux,Depressive disorder, not elsewhere classified,Personal history of venous thrombosis and embolism'}


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: Generalized seizure

PRESENT ILLNESS: The patient is a 41 yr old man with known recurrent glioblastoma
multiforme that is managed by a Dr. [**First Name (STitle) **]. He was brought to the
[**Hospital1 **] after he sustained a 3 minute generalized seizure [**Hospital1 14630**]. According to eyewitnesses, the patient became rigid
sitting in his chair watching the baseball game, and was carried
out of his chiar by family and friends. [**Name (NI) 6**] unsuccessful attempt
was made to intubate the patient in the field, when he was
emergently brought to [**Hospital1 **], had a GCS score of 8, and was
emergently intubated. Shortly thereafter, he was loaded with
Dilantin 1 gram and given 12 mg of IV Ativan for "seizure
activity." Upon arrival, I witnessed the patient to be
tremulous, but not actively seizing.
The family was able to tell me that the patient was diagnosed
with glioblastoma multiforme in [**2186-5-2**], and had 70% of the
tumor removed last year with a left frontal lobectomy.  His
presenting symptom which led to the diagnosis of the tumor was a
seizure, and he has had various types of seizures since,
including GTC. His last prolonged seizure lasted about an hour
and he was intubated at [**Hospital3 2576**] [**Hospital3 **] in [**2187-7-3**].
After this seizure, he has been cognitively slower than ever
before. He has been maintained on the current doses of keppra,
zonegran, and steroids for quite some time.

MEDICAL HISTORY: -glioblastoma multiforme as above
-sz disorder
-DVT's
-depression
-gerd

MEDICATION ON ADMISSION: Zonegran 500mg qd
Keppra 2000qAM, 1500mg qPM
Decadron 1mg [**Hospital1 **]
Lovenox 60mg [**Hospital1 **]
Celexa
Iressa
Sirolimus

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:  T-afeb   BP-119/71   HR-95   RR-9
Gen:  lying in bed, intubated sedated
Heent: L frontal craniotomy scar
Neck: supple, no carotid bruits
Chest: clear to auscultation b/l
CV:regular rate, normal s1s2, no m/r/g

FAMILY HISTORY: 

SOCIAL HISTORY: He is a former attorney, lives with his wife and three children. 

### Response:
{'Malignant neoplasm of frontal lobe,Other convulsions,Esophageal reflux,Depressive disorder, not elsewhere classified,Personal history of venous thrombosis and embolism'}
