CHIEF COMPLAINT: Headache

PRESENT ILLNESS: 47 year old female presents with 4 weeks of headaches,
dizziness, concentration difficulty, word finding difficulty,
and
fatigue. She has not had a physical since [**2147**]. She went to a
doctor for the headaches last week and was started on Fioricet;
however, this did not improve her symptoms. Today, while at
work,
she had the worst headache of her life and she was brought here
by a co-worker. The patient cannot recall all the events of this
morning but her co-worker reported that she had word finding
difficulty today as well. Currently, after receiving pain
medication in the ER, the headache is [**4-8**], down from [**8-9**] upon
arrival. The patient has had no gait disturbances, visual
changes, weight loss, numbness, or weakness.
She does not have any chest pain or SOB.

MEDICAL HISTORY: NONE

MEDICATION ON ADMISSION: Fioricet

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T:98  BP:127/73     HR:72    RR:18       O2Sats:97%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL         EOMs-intact with lateral nystagmus
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
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. Occasional word finding
difficulty.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: lives with her partner, works as a creative director
for a medical supply company
Malignant neoplasm of temporal lobe,Iatrogenic pneumothorax,Hemorrhage complicating a procedure,Compression of brain,Tobacco use disorder
Mal neo temporal lobe,Iatrogenic pneumothorax,Hemorrhage complic proc,Compression of brain,Tobacco use disorder
Admission Date:  [**2156-3-30**]              Discharge Date:   [**2156-4-15**]

Date of Birth:  [**2109-2-1**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1854**]
Chief Complaint:
Headache

Major Surgical or Invasive Procedure:
None


History of Present Illness:
47 year old female presents with 4 weeks of headaches,
dizziness, concentration difficulty, word finding difficulty,
and
fatigue. She has not had a physical since [**2147**]. She went to a
doctor for the headaches last week and was started on Fioricet;
however, this did not improve her symptoms. Today, while at
work,
she had the worst headache of her life and she was brought here
by a co-worker. The patient cannot recall all the events of this
morning but her co-worker reported that she had word finding
difficulty today as well. Currently, after receiving pain
medication in the ER, the headache is [**4-8**], down from [**8-9**] upon
arrival. The patient has had no gait disturbances, visual
changes, weight loss, numbness, or weakness.
She does not have any chest pain or SOB.


Past Medical History:
NONE

Social History:
lives with her partner, works as a creative director
for a medical supply company


Family History:
Noncontributory

Physical Exam:
T:98  BP:127/73     HR:72    RR:18       O2Sats:97%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL         EOMs-intact with lateral nystagmus
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
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. Occasional word finding
difficulty.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 2 to 1 mm
bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally with
lateral nystagmus noted bilaterally.
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 [**4-3**] throughout. No pronator drift.

Sensation: Intact to light touch bilaterally.

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger


Pertinent Results:
[**2156-3-30**] 02:53PM   K+-3.9
[**2156-3-30**] 02:53PM   O2 SAT-91 CARBOXYHB-8*
[**2156-3-30**] 02:50PM   GLUCOSE-119* UREA N-13 CREAT-0.7 SODIUM-136
POTASSIUM-5.3* CHLORIDE-102 TOTAL CO2-26 ANION GAP-13
[**2156-3-30**] 02:50PM   estGFR-Using this
[**2156-3-30**] 02:50PM   WBC-9.1 RBC-4.81 HGB-14.7 HCT-43.1 MCV-90
MCH-30.5 MCHC-34.0 RDW-13.7
[**2156-3-30**] 02:50PM   CALCIUM-9.3 PHOSPHATE-4.2 MAGNESIUM-2.1
[**2156-3-30**] 02:50PM   PLT COUNT-200
[**2156-3-30**] 02:50PM   PT-11.9 PTT-24.8 INR(PT)-1.0

[**3-30**] CT HEAD:
Large temporal lobe mass with significant associated edema and
mass effect including subfalcine, uncal and transtentorial
herniation. Appearance is most consistent with metastasis,
although at this time, there is no known underlying primary
tumor.

An MR is recommended to further characterize this mass.

[**3-30**] MR HEAD:
There is a large, 5.8 x 5.0 x 4.4 cm mass arising from the left
sphenoid [**Doctor First Name 362**]. This mass is hypointense on T1-weighted imaging
but enhances homogeneously following administration of
Gadolinium. Central hypointensity on T1-weighted images and
hyperintensity on T2-weighted images is likely secondary to
central necrosis. FLAIR images demonstrate significant
surrounding edema. There is extensive mass effect with rightward
shift of 8 mm and associated subfalcine herniation. There is
also uncal herniation secondary to local mass effect. Evaluation
of post-contrast images demonstrate enhancement of the [**Doctor First Name 500**]
adjacent to the mass suggesting that this mass is infiltrating
the [**Doctor First Name 500**] locally. Diffusion-weighted images reveal no associated
infarct. No definitive blood supply is identified based on these
images. The signal intensity values of brain parenchyma are
otherwise normal. The visualized portions of the paranasal
sinuses are unremarkable. The major vascular flow patterns are
normal.

IMPRESSION: Large, enhancing mass arising from the sphenoid [**Doctor First Name 362**]
on the left with MR characteristics of a meningioma. Significant
associated mass effect including subfalcine herniation,
rightward shift and uncal herniation.


Brief Hospital Course:
The patient is a 47 year old woman with headache of 4 weeks
duration associated with word finding difficulties and poor
concentration found to have large left temporal mass consistent
with meningioma arising from the left sphenoid [**Doctor First Name 362**] on MRI.
There was significant mass effect and 8mm shift adjacent to the
left temporal mass.

The patient was treated with dexamethasone and dilantin in
addition to analgaesia, and closely observed in hospital.
Symptoms and examination remained stable.  Embolization of the
left temporal mass occurred on [**2156-4-6**]. She proceeded to
resection of left craniotomy and excision of left temporal mass
on [**2159-4-8**]. After the skull was removed, the brain was noted to
be acutely swollen and a bleed was noted behind the meningioma.
It took approximately 30 minutes to get to the tumor and stop
the bleeding, the patient was given Mannitol interoperatively.
Post operative CT scan showed there has been massive progression
of intracranial mass effect with approximately 12 mm of
subfalcine herniation with obliteration of most sulci
bilaterally. There is massive uncal transtentorial herniation
with involvement of the left temporal [**Doctor Last Name 534**]. A large collection
of air is noted along the frontal and temporal lobes with fluid
and air within the resection bed as well as foci of hemorrhage
within the left temporal lobe. She was kept intubated for first
24 hours given high dose Mannitol and steroids. A central line
was placed for poor access and unfornatley she suffered a
pneumothorax requiring a chest tube placement.   On post
operative day 1 she was extubated and following commands, no
motor deficits with short term memory deficits and expressive
partial aphasia.  Post Operative MRI showed:  No evidence of
residual neoplasm on post-gadolinium sequences, though
evaluation in the immediate postoperative period is limited due
to intrinsic T1 hyperintense blood product and a follow up MRI
at a later date, as clinically indicated, would improve
sensitivity.

She moved to the neurostep down on Post op day 3, she remained
hemodynamically intact, with a chest tube in place followed by
general surgery.  Her speech and ability to reason and follow
complex commands improved slowly.

On [**4-12**] she was transferred to the floor and the results of
her biopsy showed ANAPLASTIC (MALIGNANT) MENINGIOMA.WHO ([**2148**])
grade 3. An immediate radiation therapy consult was obtained.

She had her chest tube discontinued on [**2156-4-14**] by the thoracics
service.  She had a minute ptx after it was discontinued.

She was tolerating regular diet and was cleared to go home with
PT/OT on [**4-15**].



Medications on Admission:
Fioricet

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule
PO BID (2 times a day).
Disp:*120 Capsule(s)* Refills:*2*
4. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) for 2 weeks.
Disp:*56 Tablet(s)* Refills:*0*
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*1*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Meningioma Grade 3
Right Pneumothorax

Discharge Condition:
Neurologically stable


Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR CRANIOTOMY

??????	Have a 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,
excessive bending
??????	You may wash your hair only after sutures and/or staples have
been removed
??????	You may shower before this time with assistance and use of a
shower cap
??????	Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit

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, drainage
??????	Fever greater than or equal to 101?????? F


Followup Instructions:
Follow up in brain tumor clinic on
You should follow up with Dr [**Last Name (STitle) 3929**].  His office will call
you prior to your appointment on [**2156-4-28**].
Follow up in Dr[**Name (NI) 9034**] office in one week for your staples to
be removed.  Call office at [**Telephone/Fax (1) 72651**] for your appointment.
Provider: [**Last Name (LF) 5302**],[**First Name8 (NamePattern2) 2352**] [**Last Name (NamePattern1) 2352**] - ADULT MEDICINE (SB)
Date/Time:[**2156-5-19**] 9:20
Provider: [**Name10 (NameIs) **] DENSITY TESTING Phone:[**Telephone/Fax (1) 4586**]
Date/Time:[**2156-5-5**] 8:40
Provider: [**Name10 (NameIs) **],[**First Name8 (NamePattern2) 2352**] [**Last Name (NamePattern1) 2352**] OB-GYN Date/Time:[**2156-4-21**] 8:45



Completed by:[**2156-4-15**]
{'Malignant neoplasm of temporal lobe,Iatrogenic pneumothorax,Hemorrhage complicating a procedure,Compression of brain,Tobacco use disorder'}


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: Headache

PRESENT ILLNESS: 47 year old female presents with 4 weeks of headaches,
dizziness, concentration difficulty, word finding difficulty,
and
fatigue. She has not had a physical since [**2147**]. She went to a
doctor for the headaches last week and was started on Fioricet;
however, this did not improve her symptoms. Today, while at
work,
she had the worst headache of her life and she was brought here
by a co-worker. The patient cannot recall all the events of this
morning but her co-worker reported that she had word finding
difficulty today as well. Currently, after receiving pain
medication in the ER, the headache is [**4-8**], down from [**8-9**] upon
arrival. The patient has had no gait disturbances, visual
changes, weight loss, numbness, or weakness.
She does not have any chest pain or SOB.

MEDICAL HISTORY: NONE

MEDICATION ON ADMISSION: Fioricet

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T:98  BP:127/73     HR:72    RR:18       O2Sats:97%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL         EOMs-intact with lateral nystagmus
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
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. Occasional word finding
difficulty.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: lives with her partner, works as a creative director
for a medical supply company 

### Response:
{'Malignant neoplasm of temporal lobe,Iatrogenic pneumothorax,Hemorrhage complicating a procedure,Compression of brain,Tobacco use disorder'}
