CHIEF COMPLAINT: Episodic confusion, left-sided weakness, left-sided neglect, and
headache

PRESENT ILLNESS: Mrs. [**Known lastname 67988**] was diagnoses in [**8-13**] with GBM by stereotactic
brain bx and started on decadron and keppra.  She received XRT
by 8 weeks and temazolamide for 3 weeks, discontinued due to
rash. Keppra was also discontinued at this time ([**2116-10-24**]).  MRI
post XRT showed that the R. temperal parietal mass was stable
and a decadron taper was begun, reducing the dose from 6 to 4 to
2mg daily over 2 weeks.  Her decadron was increased to 2mg [**Hospital1 **]
on [**11-30**].  On [**12-4**], Mrs. [**Known lastname 67988**] almost fell, was caught by her
husband who noted that her legs were intertwined.  She was also
confused for 1-2 minutes, but had no post-ictal confusion or
incontinence.  That night, she had another 5 minute episode of
sharp, sudden-onset headache over her right eyebrow, confusion,
and falling.     Head CT outside on [**2116-12-4**] did show a 9 mm
midline shift and when compared to an MRI of the head done on
[**2116-11-30**] at [**Hospital1 **], there was only a 2-3 mm shift and review of
the head CT also showed signs of tight uncus with increased
swelling, although no frank herniation.  On arrival, she
continued to be disoriented and had a [**10-18**] right-sided headache.
 She vomited twice. She was admitted to the ICU.

MEDICAL HISTORY: 1. hypertension
2. cervical spine surgery (at [**Hospital3 3765**] in [**Location (un) 1514**], MA)
3. hysterectomy for uterine fibroids
4. basal carcinoma, left side of nose (1st dx'd 20 yrs ago and
excised then 5 yrs ago required Mohs x3 as plastic surgeon
reports cancer and grown into deep structures of the face)
5. eczema well controlled with topical corticosteroids
6. carpel tunnel
7. seasonal allergies; allergy to dust, cats and feathers
8. normal colonscopy approx 3 yrs ago

MEDICATION ON ADMISSION: Keppra 500po [**Hospital1 **]
Decadron 4mg po daily
Famotidine 20mg po daily

ALLERGIES: Penicillins / Sulfa (Sulfonamides)

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VITALS: 97.4/99.1  p 68(53-71) 117/44(86/35-140/65) 17(19-21)
96% on 3L
GENERAL:  She is alert, pleasant elderly lady in no acute
distress.
CARDIOVASCULAR:  She had regular rate and rhythm.  No murmurs,
gallops, or rubs.
LUNGS:  Clear to auscultation bilaterally.
ABD: SNTND, +BS
EXTREMITIES:  No clubbing, cyanosis, or edema.
NEUROLOGICAL EXAMINATION:
MS:
Orientation: [**Hospital3 **], [**2116-11-8**] (no date)
Attn: Months of year backwards: "[**Month (only) 1096**], [**Month (only) **], [**Month (only) **],
stop"
Memory: Registration intact, Recall 0/3 at 5min
Language: Fluent, good comprehension and repetition. No
dysarthria, appropriate prosody, naming intact
Fronto-Parietal: Calculation intact, no apraxia, slight left
neglect, clock draw shows good planning, cannot copy cube or
intersecting pentagons
Coordination: She had normal appendicular coordination.
Gait: Deferred
CN: I: Not tested
    II:  R. anisocoria (stable since birth), both reactive to
light, sharp disc
         margins
III,IV,VI: EOMI, no nystagmus, does not completely bury
   V,VII: Facial strength, sensation intact/symmetrical
    VIII: Hearing intact to finger rub b/l
    IX,X: Palate elevation midline
      [**Doctor First Name 81**]: SCM/Trap full strength
     XII: Tongue midline, no fasciculations
Motor:
Normal bulk/tone b/l.  No abnormal movements/tremors.  Quite
mild l. hemiparesis, [**5-13**] deltoid and triceps, tibialis anterior.
 No drift.
Reflexes: 2 right/left at
biceps,triceps,brachioradialis,patellar,achilles
Coordination: Slight delay on finger-nose, normal [**Doctor First Name **]
Gait: Deferred

FAMILY HISTORY: Mother had DM2 and died of vulvar/rectal ca.  Father died of
CAD.

SOCIAL HISTORY: Lives with husband in in-law apartment in daughter's home. 40
pack year history smoking cigarettes, no ETOH, or illicit drug
use.
Malignant neoplasm of brain, unspecified,Other convulsions,Unspecified essential hypertension
Malig neo brain NOS,Convulsions NEC,Hypertension NOS
Admission Date:  [**2116-12-5**]              Discharge Date:   [**2116-12-9**]

Date of Birth:  [**2047-5-8**]             Sex:   F

Service: NEUROLOGY

Allergies:
Penicillins / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 2090**]
Chief Complaint:
Episodic confusion, left-sided weakness, left-sided neglect, and
headache

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mrs. [**Known lastname 67988**] was diagnoses in [**8-13**] with GBM by stereotactic
brain bx and started on decadron and keppra.  She received XRT
by 8 weeks and temazolamide for 3 weeks, discontinued due to
rash. Keppra was also discontinued at this time ([**2116-10-24**]).  MRI
post XRT showed that the R. temperal parietal mass was stable
and a decadron taper was begun, reducing the dose from 6 to 4 to
2mg daily over 2 weeks.  Her decadron was increased to 2mg [**Hospital1 **]
on [**11-30**].  On [**12-4**], Mrs. [**Known lastname 67988**] almost fell, was caught by her
husband who noted that her legs were intertwined.  She was also
confused for 1-2 minutes, but had no post-ictal confusion or
incontinence.  That night, she had another 5 minute episode of
sharp, sudden-onset headache over her right eyebrow, confusion,
and falling.     Head CT outside on [**2116-12-4**] did show a 9 mm
midline shift and when compared to an MRI of the head done on
[**2116-11-30**] at [**Hospital1 **], there was only a 2-3 mm shift and review of
the head CT also showed signs of tight uncus with increased
swelling, although no frank herniation.  On arrival, she
continued to be disoriented and had a [**10-18**] right-sided headache.
 She vomited twice. She was admitted to the ICU.

Past Medical History:
1. hypertension
2. cervical spine surgery (at [**Hospital3 3765**] in [**Location (un) 1514**], MA)
3. hysterectomy for uterine fibroids
4. basal carcinoma, left side of nose (1st dx'd 20 yrs ago and
excised then 5 yrs ago required Mohs x3 as plastic surgeon
reports cancer and grown into deep structures of the face)
5. eczema well controlled with topical corticosteroids
6. carpel tunnel
7. seasonal allergies; allergy to dust, cats and feathers
8. normal colonscopy approx 3 yrs ago



Social History:
Lives with husband in in-law apartment in daughter's home. 40
pack year history smoking cigarettes, no ETOH, or illicit drug
use.


Family History:
Mother had DM2 and died of vulvar/rectal ca.  Father died of
CAD.

Physical Exam:
PHYSICAL EXAMINATION:
VITALS: 97.4/99.1  p 68(53-71) 117/44(86/35-140/65) 17(19-21)
96% on 3L
GENERAL:  She is alert, pleasant elderly lady in no acute
distress.
CARDIOVASCULAR:  She had regular rate and rhythm.  No murmurs,
gallops, or rubs.
LUNGS:  Clear to auscultation bilaterally.
ABD: SNTND, +BS
EXTREMITIES:  No clubbing, cyanosis, or edema.
NEUROLOGICAL EXAMINATION:
MS:
Orientation: [**Hospital3 **], [**2116-11-8**] (no date)
Attn: Months of year backwards: "[**Month (only) 1096**], [**Month (only) **], [**Month (only) **],
stop"
Memory: Registration intact, Recall 0/3 at 5min
Language: Fluent, good comprehension and repetition. No
dysarthria, appropriate prosody, naming intact
Fronto-Parietal: Calculation intact, no apraxia, slight left
neglect, clock draw shows good planning, cannot copy cube or
intersecting pentagons
Coordination: She had normal appendicular coordination.
Gait: Deferred
CN: I: Not tested
    II:  R. anisocoria (stable since birth), both reactive to
light, sharp disc
         margins
III,IV,VI: EOMI, no nystagmus, does not completely bury
   V,VII: Facial strength, sensation intact/symmetrical
    VIII: Hearing intact to finger rub b/l
    IX,X: Palate elevation midline
      [**Doctor First Name 81**]: SCM/Trap full strength
     XII: Tongue midline, no fasciculations
Motor:
Normal bulk/tone b/l.  No abnormal movements/tremors.  Quite
mild l. hemiparesis, [**5-13**] deltoid and triceps, tibialis anterior.
 No drift.
Reflexes: 2 right/left at
biceps,triceps,brachioradialis,patellar,achilles
Coordination: Slight delay on finger-nose, normal [**Doctor First Name **]
Gait: Deferred


Pertinent Results:
[**2116-12-9**] 06:25AM BLOOD WBC-8.6 RBC-3.52* Hgb-11.5* Hct-34.2*
MCV-97 MCH-32.8* MCHC-33.7 RDW-17.0* Plt Ct-203
[**2116-12-8**] 06:20AM BLOOD WBC-6.2 RBC-3.38* Hgb-11.1* Hct-32.8*
MCV-97 MCH-32.7* MCHC-33.7 RDW-17.3* Plt Ct-199
[**2116-12-7**] 04:58AM BLOOD WBC-8.4 RBC-3.10* Hgb-10.7* Hct-29.8*
MCV-96 MCH-34.5* MCHC-36.0* RDW-17.8* Plt Ct-181
[**2116-12-6**] 03:00AM BLOOD WBC-6.6 RBC-3.55* Hgb-12.0 Hct-33.9*
MCV-95 MCH-33.8* MCHC-35.5* RDW-17.8* Plt Ct-179
[**2116-12-4**] 11:00PM BLOOD WBC-6.1 RBC-3.59* Hgb-12.3 Hct-34.3*
MCV-95 MCH-34.3* MCHC-35.9* RDW-18.1* Plt Ct-186
[**2116-12-9**] 06:25AM BLOOD Plt Ct-203
[**2116-12-9**] 06:25AM BLOOD Glucose-76 UreaN-18 Creat-0.7 Na-141
K-4.0 Cl-103 HCO3-28 AnGap-14
[**2116-12-9**] 06:25AM BLOOD Calcium-9.1 Phos-3.5 Mg-2.2
[**2116-12-8**] 06:20AM BLOOD Calcium-8.8 Phos-3.7 Mg-2.3
[**2116-12-9**] 06:25AM BLOOD Osmolal-297
[**2116-12-8**] 09:21PM BLOOD Osmolal-295

[**2116-12-6**] 03:00AM BLOOD Phenyto-10.2
[**2116-12-5**] 04:12PM BLOOD Phenyto-13.6

Brief Hospital Course:
Ms. [**Known lastname 67988**] was admitted to the ICU on [**12-4**]. The patient was
loaded with Decadron 10 mg and then put on Decadron 4mg q6hrs.
She was also loaded with Dilantin because of the history of the
seizures and the Keppra was increased to 750 twice a day,
frequent neuro checks were done and a repeat MRI of the brain
was considered and neurosurgery was consulted.  Mannitol 20% was
begun 25g IV q6hrs, checking serum Na and osms prior to each
dose.  Headache was managed with toradol q6 hrs.  Neurosurgery
discussed potential surgical options with the family, and they
decided on no neurosurgical intervention at this time.  While in
the ICU, her clinical condition improved, and she became more
oriented.  Her left-sided neglect and left-sided weakness
persisted.  On [**12-7**], Ms. [**Known lastname 67988**] was transferred to the floor.
Mannitol was weaned to 12.5mg [**Hospital1 **] with the last dose the morning
of [**12-9**].  PT/OT were consulted who cleared her for home with
services and a rolling walker.  She will have follow-up with Dr.
[**Last Name (STitle) 724**] in the brain tumor clinic.


Medications on Admission:
Keppra 500po [**Hospital1 **]
Decadron 4mg po daily
Famotidine 20mg po daily

Discharge Medications:
1. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*2*
2. Decadron 4 mg Tablet Sig: 1.5 Tablets PO every six (6) hours.
Disp:*180 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] Nursing Services

Discharge Diagnosis:
Gliobastoma multiforme
Seizures


Discharge Condition:
Stable. Baseline left superior field cut, left nasolabial fold
flattening, left hemiparesis, left neglect.


Discharge Instructions:
Please take all of your medications as directed.

Please return to the Emergency Room if you experience headaches,
visual changes, lethargy, speech or language problems, new
weakness, nausea, or vomiting.

Followup Instructions:
Please call Dr.[**Name (NI) 6767**] office at [**Telephone/Fax (1) 1844**] to schedule follow
up.


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 43**] MD [**MD Number(1) 2107**]
{'Malignant neoplasm of brain, unspecified,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: Episodic confusion, left-sided weakness, left-sided neglect, and
headache

PRESENT ILLNESS: Mrs. [**Known lastname 67988**] was diagnoses in [**8-13**] with GBM by stereotactic
brain bx and started on decadron and keppra.  She received XRT
by 8 weeks and temazolamide for 3 weeks, discontinued due to
rash. Keppra was also discontinued at this time ([**2116-10-24**]).  MRI
post XRT showed that the R. temperal parietal mass was stable
and a decadron taper was begun, reducing the dose from 6 to 4 to
2mg daily over 2 weeks.  Her decadron was increased to 2mg [**Hospital1 **]
on [**11-30**].  On [**12-4**], Mrs. [**Known lastname 67988**] almost fell, was caught by her
husband who noted that her legs were intertwined.  She was also
confused for 1-2 minutes, but had no post-ictal confusion or
incontinence.  That night, she had another 5 minute episode of
sharp, sudden-onset headache over her right eyebrow, confusion,
and falling.     Head CT outside on [**2116-12-4**] did show a 9 mm
midline shift and when compared to an MRI of the head done on
[**2116-11-30**] at [**Hospital1 **], there was only a 2-3 mm shift and review of
the head CT also showed signs of tight uncus with increased
swelling, although no frank herniation.  On arrival, she
continued to be disoriented and had a [**10-18**] right-sided headache.
 She vomited twice. She was admitted to the ICU.

MEDICAL HISTORY: 1. hypertension
2. cervical spine surgery (at [**Hospital3 3765**] in [**Location (un) 1514**], MA)
3. hysterectomy for uterine fibroids
4. basal carcinoma, left side of nose (1st dx'd 20 yrs ago and
excised then 5 yrs ago required Mohs x3 as plastic surgeon
reports cancer and grown into deep structures of the face)
5. eczema well controlled with topical corticosteroids
6. carpel tunnel
7. seasonal allergies; allergy to dust, cats and feathers
8. normal colonscopy approx 3 yrs ago

MEDICATION ON ADMISSION: Keppra 500po [**Hospital1 **]
Decadron 4mg po daily
Famotidine 20mg po daily

ALLERGIES: Penicillins / Sulfa (Sulfonamides)

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VITALS: 97.4/99.1  p 68(53-71) 117/44(86/35-140/65) 17(19-21)
96% on 3L
GENERAL:  She is alert, pleasant elderly lady in no acute
distress.
CARDIOVASCULAR:  She had regular rate and rhythm.  No murmurs,
gallops, or rubs.
LUNGS:  Clear to auscultation bilaterally.
ABD: SNTND, +BS
EXTREMITIES:  No clubbing, cyanosis, or edema.
NEUROLOGICAL EXAMINATION:
MS:
Orientation: [**Hospital3 **], [**2116-11-8**] (no date)
Attn: Months of year backwards: "[**Month (only) 1096**], [**Month (only) **], [**Month (only) **],
stop"
Memory: Registration intact, Recall 0/3 at 5min
Language: Fluent, good comprehension and repetition. No
dysarthria, appropriate prosody, naming intact
Fronto-Parietal: Calculation intact, no apraxia, slight left
neglect, clock draw shows good planning, cannot copy cube or
intersecting pentagons
Coordination: She had normal appendicular coordination.
Gait: Deferred
CN: I: Not tested
    II:  R. anisocoria (stable since birth), both reactive to
light, sharp disc
         margins
III,IV,VI: EOMI, no nystagmus, does not completely bury
   V,VII: Facial strength, sensation intact/symmetrical
    VIII: Hearing intact to finger rub b/l
    IX,X: Palate elevation midline
      [**Doctor First Name 81**]: SCM/Trap full strength
     XII: Tongue midline, no fasciculations
Motor:
Normal bulk/tone b/l.  No abnormal movements/tremors.  Quite
mild l. hemiparesis, [**5-13**] deltoid and triceps, tibialis anterior.
 No drift.
Reflexes: 2 right/left at
biceps,triceps,brachioradialis,patellar,achilles
Coordination: Slight delay on finger-nose, normal [**Doctor First Name **]
Gait: Deferred

FAMILY HISTORY: Mother had DM2 and died of vulvar/rectal ca.  Father died of
CAD.

SOCIAL HISTORY: Lives with husband in in-law apartment in daughter's home. 40
pack year history smoking cigarettes, no ETOH, or illicit drug
use. 

### Response:
{'Malignant neoplasm of brain, unspecified,Other convulsions,Unspecified essential hypertension'}
