CHIEF COMPLAINT: Left Occipital Brain Mass recurrance

PRESENT ILLNESS: Patient is being electively admitted for recurrent occipital
brain mass.

MEDICAL HISTORY: Hypertension, Hyperlipidemia, Osteopenia, GERD, Hypthyrodism
s/p thyroidectomy, Diverticulosis, Glaucoma, s/p TAH, s/p
craniotomy [**2128**] for Glioma

MEDICATION ON ADMISSION: Dexamethasone 4mg qam 2mg qpm, Keppra 1000mg [**Hospital1 **], Levothyroxine
88 mcg daily, Metoprolol tartrate 25mg [**Hospital1 **], Omeprazole 40mg [**Hospital1 **],
Percocet 5mg-325mg q4hr:prn, Simvastatin 40mg daily, Timolol
0.5% 1 drop each eye daily, Colace 100mg [**Hospital1 **]

ALLERGIES: Sulfa (Sulfonamides) / Keflex / Ibuprofen

PHYSICAL EXAM: On Discharge:
Alert and oriented to name and hosptial. Pupils equal, round and
reactive to light. Spontaneous eye opening. EOM grossly intact
with two beat left gaze nystagmus. No pronator drift, however
right sided dysmetria. Moves all extremities spontaneously and
symmetrically with full strength. Sensation grossly intact.

FAMILY HISTORY: Colon CA and Diabetes

SOCIAL HISTORY: Resides at home with daughter.
Malignant neoplasm of occipital lobe,Other emphysema,Unspecified acquired hypothyroidism,Esophageal reflux,Disorder of bone and cartilage, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension
Mal neo occipital lobe,Emphysema NEC,Hypothyroidism NOS,Esophageal reflux,Bone & cartilage dis NOS,Hyperlipidemia NEC/NOS,Hypertension NOS
Admission Date:  [**2131-2-15**]              Discharge Date:   [**2131-2-20**]

Date of Birth:  [**2061-12-10**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Sulfa (Sulfonamides) / Keflex / Ibuprofen

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Left Occipital Brain Mass recurrance

Major Surgical or Invasive Procedure:
[**2-15**]: Left Occipital Craniotomy for Mass Resection


History of Present Illness:
Patient is being electively admitted for recurrent occipital
brain mass.

Past Medical History:
Hypertension, Hyperlipidemia, Osteopenia, GERD, Hypthyrodism
s/p thyroidectomy, Diverticulosis, Glaucoma, s/p TAH, s/p
craniotomy [**2128**] for Glioma

Social History:
Resides at home with daughter.

Family History:
Colon CA and Diabetes


Physical Exam:
On Discharge:
Alert and oriented to name and hosptial. Pupils equal, round and
reactive to light. Spontaneous eye opening. EOM grossly intact
with two beat left gaze nystagmus. No pronator drift, however
right sided dysmetria. Moves all extremities spontaneously and
symmetrically with full strength. Sensation grossly intact.

Pertinent Results:
Labs on Admission:
[**2131-2-16**] 03:37AM BLOOD WBC-20.3*# RBC-3.27* Hgb-9.8* Hct-29.1*
MCV-89 MCH-30.1 MCHC-33.8 RDW-19.0* Plt Ct-192
[**2131-2-16**] 03:37AM BLOOD PT-12.7 PTT-22.5 INR(PT)-1.1
[**2131-2-16**] 03:37AM BLOOD Glucose-137* UreaN-19 Creat-1.0 Na-140
K-4.5 Cl-106 HCO3-25 AnGap-14
[**2131-2-16**] 03:37AM BLOOD Calcium-9.3 Phos-4.2 Mg-1.9

Labs on Discharge:
[**2131-2-19**] 06:19AM BLOOD WBC-13.2* RBC-2.94* Hgb-9.1* Hct-26.5*
MCV-90 MCH-31.0 MCHC-34.4 RDW-19.0* Plt Ct-271
[**2131-2-19**] 06:19AM BLOOD PT-12.0 PTT-28.0 INR(PT)-1.0
[**2131-2-19**] 06:19AM BLOOD Glucose-81 UreaN-17 Creat-0.9 Na-141
K-4.3 Cl-105 HCO3-25 AnGap-15
[**2131-2-19**] 06:19AM BLOOD Calcium-9.2 Phos-3.1 Mg-2.1

Imaging:
MRI Wand [**2-16**]:
TECHNIQUE: Limited imaging of the brain was performed,
post-contrast, using spin-echo and MP-RAGE sequences.
FINDINGS:
There is a large heterogeneously enhancing lesion, in the left
posterior
temporal and the occipital lobes, extending to the splenium of
the corpus
callosum as well as into the periatrial region, not
significantly changed,
compared to the most recent CT scan allowing for the technical
differences. A few areas of increased signal, in the adjacent
bone, are again unchanged. There is minimal shift of the midline
structures to the right side, not significantly changed.
Continued mass effect, on the atrium and posterior part of the
body of the left lateral ventricle and effacement of the
occipital [**Doctor Last Name 534**] and sulci, unchanged. Pachymeningeal enhancement,
of the tentorium, and the adjacent dura along the
convexity is also unchanged. There is near total/total empty
sella, with no definite pituitary gland visualized, unchanged.
IMPRESSION:
1. Large heterogeneous lesion, in the left posterior temporal
and the
occipital lobes, extending into splenium, with mass effect on
the left lateral ventricle, may relate to glioma/radiation
necrosis, demonstrated for surgical planning, not significantly
changed.

MRI Head(post-op) [**2-16**]:
Comparison is made with preoperative study from [**2131-2-15**].
There are postoperative changes in the left occipital lobe
including a post op cavity. There is some hemorrhage within the
operative bed. There is residual enhancement in the left
occipital lobe and temporal lobe with
enhancement extending into the splenium of the corpus callosum.
There is a
small amount of restricted diffusion along the margins of the
ostoperative
cavity and within the enhancing tumor mass in the temporal lobe.
This could represent foci of acute ischemia. There is dural
enhancement in the left hemisphere which is likely postoperative
in nature. There is a small subgaleal fluid collection on the
left. Intracranial flow voids are maintained. There is bilateral
mastoid opacification.

Pathology [**2-15**]:
DIAGNOSIS:
   I.  Foreign body:
Gross examination only.
  II.  Brain, left occipital, resection (A):
Glioblastoma, WHO grade IV (See note).
 III.  Brain, left occipital, resection (B-M):
Glioblastoma, WHO grade IV (See note).
IV.  Brain, left occipital, resection (N-O):
Glioblastoma, WHO grade IV (See note).

Brief Hospital Course:
Patient was electively admitted on [**2-15**] for excision of
recurrent mass in the left occipital lobe. She was monitored
post-operatively in the ICU overnight. After an uneventful stay,
she was transferred to the neurosurgery floor. Prior to
transfer, MRI was performed showing expected residual mass.
Physical and occupational therapy were consulted and determined
her to be an appropriate candidate for home with her family and
outpatient services, and she was discharged on [**2-20**] with follow
up arranged.

Medications on Admission:
Dexamethasone 4mg qam 2mg qpm, Keppra 1000mg [**Hospital1 **], Levothyroxine
88 mcg daily, Metoprolol tartrate 25mg [**Hospital1 **], Omeprazole 40mg [**Hospital1 **],
Percocet 5mg-325mg q4hr:prn, Simvastatin 40mg daily, Timolol
0.5% 1 drop each eye daily, Colace 100mg [**Hospital1 **]

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
5. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO bid ().
Disp:*60 Tablet(s)* Refills:*0*
6. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Lisinopril 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
8. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
10. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
VNA of the [**Location (un) 1121**]

Discharge Diagnosis:
Left Occipital Brain Mass


Discharge Condition:
Neurologically Stable


Discharge Instructions:
General Instructions/Information

??????	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 sutures have been removed.
??????	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.
??????	You are being sent home on steroid medication, make sure you
are taking a medication to protect your stomach (Prilosec,
Protonix, or Pepcid), as these medications can cause stomach
irritation.  Make sure to take your steroid medication with
meals, or a glass of milk.
??????	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.
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: increasing redness,
increased swelling, increased tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.

Followup Instructions:
Follow-Up Appointment Instructions

??????Please return to the office in [**6-29**] days (from your date of
surgery) for removal of your sutures and a wound check. This
appointment can be made with the Nurse Practitioner.  Please
make this appointment by calling [**Telephone/Fax (1) 1669**]. If you live quite
a distance from our office, please make arrangements for the
same, with your PCP.
??????You have an appointment in the Brain [**Hospital 341**] Clinic on [**2131-3-12**] at 11:30am.  The Brain [**Hospital 341**] Clinic is located on the [**Hospital Ward Name 5074**] of [**Hospital1 18**], in the [**Hospital Ward Name 23**] Building. Their phone number is
[**Telephone/Fax (1) 1844**]. Please call if you need to change your
appointment, or require additional directions.
??????You will not need an MRI of the brain, as this was done during
your acute hospitalization.



Completed by:[**2131-2-20**]
{'Malignant neoplasm of occipital lobe,Other emphysema,Unspecified acquired hypothyroidism,Esophageal reflux,Disorder of bone and cartilage, unspecified,Other and unspecified hyperlipidemia,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: Left Occipital Brain Mass recurrance

PRESENT ILLNESS: Patient is being electively admitted for recurrent occipital
brain mass.

MEDICAL HISTORY: Hypertension, Hyperlipidemia, Osteopenia, GERD, Hypthyrodism
s/p thyroidectomy, Diverticulosis, Glaucoma, s/p TAH, s/p
craniotomy [**2128**] for Glioma

MEDICATION ON ADMISSION: Dexamethasone 4mg qam 2mg qpm, Keppra 1000mg [**Hospital1 **], Levothyroxine
88 mcg daily, Metoprolol tartrate 25mg [**Hospital1 **], Omeprazole 40mg [**Hospital1 **],
Percocet 5mg-325mg q4hr:prn, Simvastatin 40mg daily, Timolol
0.5% 1 drop each eye daily, Colace 100mg [**Hospital1 **]

ALLERGIES: Sulfa (Sulfonamides) / Keflex / Ibuprofen

PHYSICAL EXAM: On Discharge:
Alert and oriented to name and hosptial. Pupils equal, round and
reactive to light. Spontaneous eye opening. EOM grossly intact
with two beat left gaze nystagmus. No pronator drift, however
right sided dysmetria. Moves all extremities spontaneously and
symmetrically with full strength. Sensation grossly intact.

FAMILY HISTORY: Colon CA and Diabetes

SOCIAL HISTORY: Resides at home with daughter. 

### Response:
{'Malignant neoplasm of occipital lobe,Other emphysema,Unspecified acquired hypothyroidism,Esophageal reflux,Disorder of bone and cartilage, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
