CHIEF COMPLAINT: L occipital grade II oligodendroglioma

PRESENT ILLNESS: This is a 55 year old F with history of Left parieto-occipital
grade II oligodendroglioma presents for elective resection

MEDICAL HISTORY: mild protein S abnormality
with 5 miscarriages, migraines since age 20, GERD, hypertension,
hiatal hernia, restless leg syndrome, vertigo, and renal
calculi, sleep apnea

MEDICATION ON ADMISSION: valium, diovan, fluoxetine, HCTZ, keppra, ativan, prilosec,
niacin, mucinex

ALLERGIES: Morphine

PHYSICAL EXAM: On Admission1/11/[**2133**]:alert and oriented to person place and
time
pupils are equal and reactive
speech is clear
pt follow commands consistently
strength sensation is full
no pronator drift
face is symetric
toungue is midline

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with her husband. Two children. Works as a teachers
assistant and at a retail store.
Malignant neoplasm of parietal lobe,Cerebral edema,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy,Primary hypercoagulable state,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Esophageal reflux,Unspecified essential hypertension,Diaphragmatic hernia without mention of obstruction or gangrene,Restless legs syndrome (RLS),Dizziness and giddiness,Obstructive sleep apnea (adult)(pediatric),Nausea alone
Mal neo parietal lobe,Cerebral edema,Psymotr epil w/o int epi,Prim hypercoagulable st,Migrne unsp wo ntrc mgrn,Esophageal reflux,Hypertension NOS,Diaphragmatic hernia,Restless legs syndrome,Dizziness and giddiness,Obstructive sleep apnea,Nausea alone
Admission Date:  [**2133-12-23**]              Discharge Date:   [**2133-12-26**]

Date of Birth:  [**2078-3-30**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Morphine

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
L occipital grade II oligodendroglioma

Major Surgical or Invasive Procedure:
L craniotomy and cranioplasty [**2133-12-23**]


History of Present Illness:
This is a 55 year old F with history of Left parieto-occipital
grade II oligodendroglioma presents for elective resection

Past Medical History:
mild protein S abnormality
with 5 miscarriages, migraines since age 20, GERD, hypertension,
hiatal hernia, restless leg syndrome, vertigo, and renal
calculi, sleep apnea

Social History:
Lives with her husband. Two children. Works as a teachers
assistant and at a retail store.


Family History:
NC

Physical Exam:
On Admission1/11/[**2133**]:alert and oriented to person place and
time
pupils are equal and reactive
speech is clear
pt follow commands consistently
strength sensation is full
no pronator drift
face is symetric
toungue is midline

On DISCHARGE1/14/[**2133**]:
alert and oriented to person place and time
pupils are equal and reactive
speech is clear
pt follow commands consistently
strength sensation is full
no pronator drift
face is symetric
toungue is midline
incision is closed with disolvable sutures. There is no
drainage, no erythema, no edema
The patient is tolerating a regular diet well and ambulates with
a steady gait independently.

Pertinent Results:
Radiology Report MR HEAD W/ CONTRAST Study Date of [**2133-12-23**]
10:01 AM RADIOLOGY IMPRESSION:
1. Redemonstration of the previously noted left parietal lesion,
measuring  approximately 1.4 x 1.6 cm demonstrated for surgical
mapping.
2. Paranasal sinus disease as described above.

Radiology Report CT HEAD W/O CONTRAST Study Date of [**2133-12-23**]
7:59 PM
RADIOLOGY FINAL IMPRESSION
1. Status post craniotomy and resection of the left parietal
lesion with
expected locules of air and blood products within the resection
bed as well as pneumocephalus as described above- attention on
close followup. Expected post-operative air and blood products
in the extracranial soft tissues adjacent to the craniotomy
site. Evaluation of the lesion resected is limited.
2. Paranasal sinus disease as above.

Pathology Report Tissue: Parietal tumor. Study Date of [**2133-12-23**]
Report not finalized.
Assigned Pathologist [**Doctor Last Name **],HASINI

Radiology Report MR HEAD W & W/O CONTRAST Study Date of [**2133-12-24**]
4:20 PM

IMPRESSION:
1. Status post interval resection of recurrent left
parieto-occipital
oligodendroglioma with expected post-surgical changes at the
resection site in this first postoperative baseline study.

2. Diffuse thickening and enhancement of the leptomeninges,
likely reactive in nature.

3. Tiny, band-like area of hyperintensity along the resection
site

4. Additional small focus of restricted diffusion in the left
frontal white matter


Brief Hospital Course:
This is a 55 year old female with history of left
parieto-occipital grade II oligodendroglioma presents for
elective resection and cranioplasty. She was taken to the OR on
[**12-23**]. She tolerated the procedure well, was extubated in the
operating room, and brought to the intensive care unit
post-operatively for further management and care. She had a
post-op Head Ct which showed expected post-op change.

On [**12-24**] she was stable in the ICU and was planned for MRI scan.
She had her MRI scan which showed post-surgical changes and she
was transferred to the floor.

On the morning of [**12-25**] on AM rounds, she was neurologically
intact.  The patient's incision was clean,d ry, and intact.  The
patient worked with Physical therapy to determine disposition.
Physical therapy cleared her for home without any need for
services.

On [**12-26**], the patient had some slight nausea which was relived
with Zofran.  The patient had a slight headache, but otherwise
was doing quite well.  The patient expressed an interest in
possible disposition home.  The patient was tolerating a regular
diet and had no further nausea or vomiting.  She was ambulating
independently with a steady gait.  The patient strength and
sensation was full.  The patient's incision was well
approximated without drainage. There was no erythema or edema.
The incision was closed with disolvable sutures.  the patient
was voiding on her own. The patient will follow up in the Brain
[**Hospital 341**] Clinic in two weeks for post operative evaluation and
wound check.

Medications on Admission:
valium, diovan, fluoxetine, HCTZ, keppra, ativan, prilosec,
niacin, mucinex


Discharge Medications:
1. valsartan 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
EVERY OTHER DAY (Every Other Day): as taken at home.
3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily): as taken at
home and while taking steroid medication.
4. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO QAM (once
a day (in the morning)).
Disp:*40 Tablet(s)* Refills:*2*
5. levetiracetam 250 mg Tablet Sig: Three (3) Tablet PO QPM
(once a day (in the evening)).
Disp:*60 Tablet(s)* Refills:*2*
6. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for Pain: do not drive while taking this medication,
do not take if lethargic.
Disp:*40 Tablet(s)* Refills:*0*
8. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): take while taking narcotic pain medication.
Disp:*60 Tablet(s)* Refills:*2*
9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): take while taking narcotic pain medication.
Disp:*60 Capsule(s)* Refills:*2*
10. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain or fever > 101.4: do not exceed 4 gram
in 24 hours this will cause liver failure.
11. dexamethasone 1 mg Tablet Sig: Three (3) Tablet PO four
times a day for 3 doses: when completed you will start the 2 mg
dosing.
Disp:*9 Tablet(s)* Refills:*0*
12. dexamethasone 1 mg Tablet Sig: Two (2) Tablet PO four times
a day for 2 days: start [**2133-12-27**] after 3 mg dosing completed.
Disp:*16 Tablet(s)* Refills:*0*
13. decadron  Sig: One (1) mg  four times a day for 2 days:
after 2 mg po q 6 hour dosing completed.
Disp:*8 * Refills:*0*
14. decadron  Sig: One (1) mg PO twice a day for 2 days: to
start after 1 mg po q 6 hour dosing completed.
Disp:*4 * Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
L parieto-occipital grade II oligodendroglioma


Discharge Condition:
alert and oriented to person, place, and time
strength is full
sensation is intact
disolvable sutures
wound is clean, dry, intact
patient is able to ambulate independently with a steady gait


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 have dissolvable sutures you may wash your hair and get
your incision wet day 3 after surgery.  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 discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	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

??????You do not yet have an appointment in the Brain [**Hospital 341**] Clinic as
you are being discharged home on the weekend and the office is
not open today.  PLEASE CALL FOR AN APPOINTMENT ON MONDAY
MORNING to be seen in TWO WEEKS.  Your wound will be evaluated
at that time as well.  The Brain [**Hospital 341**] Clinic is located on the
[**Hospital Ward Name 516**] of [**Hospital1 18**], in the [**Hospital Ward Name 23**] Building, [**Location (un) **]. Their
phone number is [**Telephone/Fax (1) 1844**]. Please call if you need to change
your appointment, or require additional directions.



Completed by:[**2133-12-26**]
{'Malignant neoplasm of parietal lobe,Cerebral edema,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy,Primary hypercoagulable state,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Esophageal reflux,Unspecified essential hypertension,Diaphragmatic hernia without mention of obstruction or gangrene,Restless legs syndrome (RLS),Dizziness and giddiness,Obstructive sleep apnea (adult)(pediatric),Nausea alone'}


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: L occipital grade II oligodendroglioma

PRESENT ILLNESS: This is a 55 year old F with history of Left parieto-occipital
grade II oligodendroglioma presents for elective resection

MEDICAL HISTORY: mild protein S abnormality
with 5 miscarriages, migraines since age 20, GERD, hypertension,
hiatal hernia, restless leg syndrome, vertigo, and renal
calculi, sleep apnea

MEDICATION ON ADMISSION: valium, diovan, fluoxetine, HCTZ, keppra, ativan, prilosec,
niacin, mucinex

ALLERGIES: Morphine

PHYSICAL EXAM: On Admission1/11/[**2133**]:alert and oriented to person place and
time
pupils are equal and reactive
speech is clear
pt follow commands consistently
strength sensation is full
no pronator drift
face is symetric
toungue is midline

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with her husband. Two children. Works as a teachers
assistant and at a retail store. 

### Response:
{'Malignant neoplasm of parietal lobe,Cerebral edema,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy,Primary hypercoagulable state,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Esophageal reflux,Unspecified essential hypertension,Diaphragmatic hernia without mention of obstruction or gangrene,Restless legs syndrome (RLS),Dizziness and giddiness,Obstructive sleep apnea (adult)(pediatric),Nausea alone'}
