CHIEF COMPLAINT: Headache and dizziness

PRESENT ILLNESS: 43 yo M with no significant PMHx who c/o 3 weeks of HA, worse in
morning and at night, with some improvement during the day.  He
went to an OSH and was found to have a left frontal mass on [**Hospital 87255**]
transferred to [**Hospital1 18**] for further workup.  He denies
nausea/vomiting, no visual disturbances, no weakness or
numbness, no seizure activity, no fevers or chills.  He denies
recent foreign travel, notes a trip to [**Location (un) 6482**] one month ago.
He denies recent weight loss or gain.  He has a 9 pack year
history of smoking and was a daily drinker until approximately
one month ago.

MEDICAL HISTORY: stab wound to L chest

MEDICATION ON ADMISSION: Ibuprofen OTC

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T: 98.6 BP: 113/74         HR: 71   R 18      O2Sats 96%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3mm react bilat        EOMs intact
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.
Recall: [**2-4**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: nc

SOCIAL HISTORY: 17 yr hx smoking ([**12-6**] ppd), daily drinker
Malignant neoplasm of frontal lobe,Cerebral edema,Aphasia,Tobacco use disorder
Malig neo frontal lobe,Cerebral edema,Aphasia,Tobacco use disorder
Admission Date:  [**2111-8-27**]              Discharge Date:   [**2111-9-4**]

Date of Birth:  [**2068-1-9**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3227**]
Chief Complaint:
Headache and dizziness

Major Surgical or Invasive Procedure:
L craniotomy for L mass resection


History of Present Illness:
43 yo M with no significant PMHx who c/o 3 weeks of HA, worse in
morning and at night, with some improvement during the day.  He
went to an OSH and was found to have a left frontal mass on [**Hospital 87255**]
transferred to [**Hospital1 18**] for further workup.  He denies
nausea/vomiting, no visual disturbances, no weakness or
numbness, no seizure activity, no fevers or chills.  He denies
recent foreign travel, notes a trip to [**Location (un) 6482**] one month ago.
He denies recent weight loss or gain.  He has a 9 pack year
history of smoking and was a daily drinker until approximately
one month ago.

Past Medical History:
stab wound to L chest

Social History:
17 yr hx smoking ([**12-6**] ppd), daily drinker

Family History:
nc

Physical Exam:
O: T: 98.6 BP: 113/74         HR: 71   R 18      O2Sats 96%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3mm react bilat        EOMs intact
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.
Recall: [**2-4**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3 to 2
mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
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 [**4-8**] throughout. No pronator drift

Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally.

Reflexes: B T Br Pa Ac
Right     2+--------->
Left      2+--------->

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, rapid alternating
movements, heel to shin

Exam upon discharge:
A&Ox3
PERRL bilateral periorbital edema
EOMs intact
Face symmetrical
tongue midline
Motor: full
Incision: c/d/i dissolvable sutures
No pronator drift

Pertinent Results:
CT/MRI: CT at OSH with L frontal mass
Labs: Na 141, K 3.7, Cl 105, CO2 25, BUN 8, Cr 0.7, Gluc 114
WBC 9.8, Hb 14.9, Hct 40.7, Plt 319

CT head [**9-2**]

Postoperative patient with evidence of left frontal craniotomy.
There is left frontal pneumocephalus as well as small amount of
hemorrhage and edema
consistent with surgery in the area.

MRI Head [**9-3**]
Expected post-surgical appearance after left frontal craniotomy
and mass resection with blood and air at the resection site.
Persistent
vasogenic edema in the left frontal lobe with residual
enhancement extending to the frontal [**Doctor Last Name 534**] of the left lateral
ventricle that may be post-surgical change or residual mass.
Recommend continued followup.


Brief Hospital Course:
43 y/o M presented with couple of weeks of headache and
dizziness. Head CT revealed L frontal mass. Pt was admitted to
neurosurgery for close monitoring.  He underwent MRI of brain
+/- which was consistent for lesion in the L frontal region. CT
torso was also performed which was negative for metastasis. He
underwent MRI wand study for pre-operative planning and was made
NPO after midnight in preperation for L frontal craniotomy on
[**9-1**].

[**9-1**] Pt underwent left frontal craniotomy for tumor resection
and biopsy. He tolerated this procedure well with no
complications and post operatively was transfered to the ICU for
further care including q1 neurochecks and strict blood pressure
control. On post op exam he was doing well and he remained non
focal. His speech remained unchanged relative to pre-op. His
surgical site was clean and dry with no active drainage and his
pain was well controlled. His CT head showed good tumor
resection and no acute hemorrhage, hydrocephalus or midline
shift.

[**2031-9-1**] Pt was transfered to the floor in stable condition. His
diet was advanced and his foley catheter was removed. He
underwent MRI of the head for post op evaluation and showed good
resection of tumor. He was seen by physical therapy and was
cleared for home without services. He will be discharged to home
in stable condition on [**9-4**] and will taper his decadron over 12
days to off.

Medications on Admission:
Ibuprofen OTC


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Butalbital-Acetaminophen-Caff 50-325-40 mg Tablet Sig: [**12-6**]
Tablets PO Q4H (every 4 hours) as needed for headache.
Disp:*60 Tablet(s)* Refills:*0*
3. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
4. Hydromorphone 2 mg Tablet Sig: 2-3 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day) for 5 days.
Disp:*20 Tablet(s)* Refills:*0*
6. Dexamethasone 2 mg Tablet Sig: as directed Tablet PO every
eight (8) hours: Please take 4mg (2tabs)Q8H for 1 day, then take
3mg (1.5 tabs)Q8H x 3 days, then 2mg(1tabs)x3 days, then
1mg(0.5tabs)x3 daysm then off.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Left frontal mass


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


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 2 weeks. 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**].
If you haven 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

??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**First Name (STitle) **], to be seen in 4 weeks.
??????You will need a CT scan of the brain without contrast.
??????       A brain tumor clinic appointment has been scheduled for
[**2111-9-21**] at 10:30am with Dr. [**Last Name (STitle) 724**]. Please call
[**Telephone/Fax (1) 1844**] with any questions. His office is located in the
[**Hospital Ward Name 23**] building on the [**Hospital Ward Name 516**].



Completed by:[**2111-9-4**]
{'Malignant neoplasm of frontal lobe,Cerebral edema,Aphasia,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 and dizziness

PRESENT ILLNESS: 43 yo M with no significant PMHx who c/o 3 weeks of HA, worse in
morning and at night, with some improvement during the day.  He
went to an OSH and was found to have a left frontal mass on [**Hospital 87255**]
transferred to [**Hospital1 18**] for further workup.  He denies
nausea/vomiting, no visual disturbances, no weakness or
numbness, no seizure activity, no fevers or chills.  He denies
recent foreign travel, notes a trip to [**Location (un) 6482**] one month ago.
He denies recent weight loss or gain.  He has a 9 pack year
history of smoking and was a daily drinker until approximately
one month ago.

MEDICAL HISTORY: stab wound to L chest

MEDICATION ON ADMISSION: Ibuprofen OTC

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T: 98.6 BP: 113/74         HR: 71   R 18      O2Sats 96%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3mm react bilat        EOMs intact
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.
Recall: [**2-4**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: nc

SOCIAL HISTORY: 17 yr hx smoking ([**12-6**] ppd), daily drinker 

### Response:
{'Malignant neoplasm of frontal lobe,Cerebral edema,Aphasia,Tobacco use disorder'}
