CHIEF COMPLAINT: seizure

PRESENT ILLNESS: Mr. [**Known lastname 11950**] is a 64 yo M with h/o NIDDM, HTN, HL who presents
with new onset seizures.
The pt was feeling unwell with N/V 1 day prior to presentation,
and went to [**Hospital3 **] where workup was negative and he was
D/Ced
home. On the day of presentation, the patient (who lives with
his
son) was fine in the morning. However, in the afternoon he
seemed
diaphoretic and chilled. His son thought he seemed "out of it."
He was focusing on something behind his son rather than making
eye contact, and would answer "I'm ok" at first, but later was
not speaking or responding. His son suggested he lie down, which
he did, and he was rolling back and forth in bed toward and away
from the fan. The son did not notice any facial droop, focal
weakness, or incontinence. He called EMS, who brought patient to
[**Hospital3 **].
The pt reportedly had 1 seizure in the ambulance with rightward
gaze deviation, and received 5 mg Valium. In the ED, the
attending witnessed another GTC with R gaze deviation. The
patient received 2 mg Ativan, 1 g Dilantin. He was intubated for
airway protection and started on propofol. Head CT showed
chronic
L parietal infarct, C-spine was normal, and CT C/A/P was
unrevealing. LP was significant for 26 WBC (10 L, 16 MONOs), 2
RBCs with normal protein and glucose (opening pressure not
reported). The pt then received Decadon 10 mg, acyclovir, CTX,
amp, and vanco.

MEDICAL HISTORY: - NIDDM c/b neuropathy
- HTN
- HL
- GERD

MEDICATION ON ADMISSION: ASA 81 mg
sitagliptin 50 mg daily
Venlafaxine 150 mg [**Hospital1 **]
Topamax 200 qhs
glipizide 5 mg daily
metoprolol 25 mg [**Hospital1 **]
amlodipine 5 mg daily
enlapril 5 mg daily
Flomax 0.4 mg qhs
vitamin B12
omeprazole 20 mg daily
zolpidem 10 mg qhs

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: At admission:
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally
Skin: no rashes or lesions noted.

FAMILY HISTORY: negative for stroke, seizure. + for DM, breast CA

SOCIAL HISTORY: lives with son, recently moved from [**Name (NI) 108**] 6 months
ago to be closer to family. Not married. Retired veteran. Smokes
less than 1pk/day, occasional marijuana, no ETOH or IVDU. Uses
cane to ambulate, independent in ADLs.
Generalized convulsive epilepsy, without mention of intractable epilepsy,Encephalopathy, unspecified,Acute kidney failure, unspecified,Cystic kidney disease, unspecified,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Chronic kidney disease, unspecified,Personal history of traumatic brain injury,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cannabis abuse, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
Gen cnv epil w/o intr ep,Encephalopathy NOS,Acute kidney failure NOS,Cystic kidney diseas NOS,Hyperlipidemia NEC/NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Chronic kidney dis NOS,Hx traumatc brain injury,Hx TIA/stroke w/o resid,BPH w/o urinary obs/LUTS,Cannabis abuse-unspec,Hy kid NOS w cr kid I-IV
Admission Date:  [**2124-6-26**]              Discharge Date:   [**2124-7-1**]

Date of Birth:  [**2060-3-13**]             Sex:   M

Service: NEUROLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Last Name (NamePattern1) 1838**]
Chief Complaint:
seizure

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known lastname 11950**] is a 64 yo M with h/o NIDDM, HTN, HL who presents
with new onset seizures.
The pt was feeling unwell with N/V 1 day prior to presentation,
and went to [**Hospital3 **] where workup was negative and he was
D/Ced
home. On the day of presentation, the patient (who lives with
his
son) was fine in the morning. However, in the afternoon he
seemed
diaphoretic and chilled. His son thought he seemed "out of it."
He was focusing on something behind his son rather than making
eye contact, and would answer "I'm ok" at first, but later was
not speaking or responding. His son suggested he lie down, which
he did, and he was rolling back and forth in bed toward and away
from the fan. The son did not notice any facial droop, focal
weakness, or incontinence. He called EMS, who brought patient to
[**Hospital3 **].
The pt reportedly had 1 seizure in the ambulance with rightward
gaze deviation, and received 5 mg Valium. In the ED, the
attending witnessed another GTC with R gaze deviation. The
patient received 2 mg Ativan, 1 g Dilantin. He was intubated for
airway protection and started on propofol. Head CT showed
chronic
L parietal infarct, C-spine was normal, and CT C/A/P was
unrevealing. LP was significant for 26 WBC (10 L, 16 MONOs), 2
RBCs with normal protein and glucose (opening pressure not
reported). The pt then received Decadon 10 mg, acyclovir, CTX,
amp, and vanco.

Per son, the patient did have a [**2060**]0 days ago with possible
head trauma, though his only visible injury was to his foot. He
has no history of seizure. He was not ill besides 1 day of N/V.

Past Medical History:
- NIDDM c/b neuropathy
- HTN
- HL
- GERD


Social History:
lives with son, recently moved from [**Name (NI) 108**] 6 months
ago to be closer to family. Not married. Retired veteran. Smokes
less than 1pk/day, occasional marijuana, no ETOH or IVDU. Uses
cane to ambulate, independent in ADLs.


Family History:
negative for stroke, seizure. + for DM, breast CA


Physical Exam:
At admission:
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally
Skin: no rashes or lesions noted.

Neurologic:
-Mental Status: off propofol 5 minutes (longer than that, he
fought vent)--> eyes barely open to sternal rub, does not follow
any commands.

-Cranial Nerves:
PERRL 5 to 2mm and brisk. Eyes midline. No facial droop.

-Motor: Normal bulk, tone throughout. No adventitious movements,
such as tremor, noted.
Uses bilateral upper extremities to localize pain in the
contralateral pain with antigravity strength.
Withdraws purposefully bilaterally in lower extremities.

-Sensory: intact to pain throughout

-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2+ 2+   2+   2+  1
R  2  2    2    2   1
Plantar response was flexor bilaterally.
.
Discharge:
General: Awake, cooperative, NAD. Asterixis bilat R>L.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally
Skin: no rashes or lesions noted.
.
Neurologic:
-Mental Status: Alert and partially oriented knew in hospital
not which and knows month/year not date. Speech fluent. Poor
memory but improving - not able to [**First Name8 (NamePattern2) **] [**Doctor Last Name 1841**] backwards but can to
DOW backwards.
.
-Cranial Nerves:
PERRL 4 to 2mm and brisk. Eyes midline. Intact VOR. No facial
droop.
Good facial power. Tongue protrudes midline. Good palatal
elevation.
-Motor: Normal bulk, tone throughout.  Good power throughout
save knee flexion on the left  and otherwise full.
-Sensory: Normal to light touch buit decreased sensation to
ankle bilaterally on temp sensation
-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    2    2   2
R  2  2    2    2   2
Adductor reflex
Plantar response was flexor bilaterally

Pertinent Results:
Admission labs:
[**2124-6-25**] 11:40PM   PT-14.0* PTT-31.2 INR(PT)-1.2*
[**2124-6-25**] 11:40PM   WBC-9.0 RBC-4.96 HGB-13.9* HCT-42.4 MCV-86
MCH-28.1 MCHC-32.9 RDW-14.5
[**2124-6-25**] 11:40PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2124-6-25**] 11:40PM   LIPASE-165*
[**2124-6-25**] 11:40PM   UREA N-11 CREAT-1.6*
.
Risk factors:
[**2124-6-29**] 06:15AM BLOOD %HbA1c-6.5* eAG-140*
[**2124-6-29**] 06:15AM BLOOD Calcium-9.1 Phos-2.3* Mg-2.1 Cholest-338*
[**2124-6-29**] 06:15AM BLOOD Triglyc-258* HDL-42 CHOL/HD-8.0
LDLcalc-244*
.
Other pertinent labs:
[**2124-6-26**] 04:23AM BLOOD ALT-10 AST-11 LD(LDH)-238 AlkPhos-139*
TotBili-0.2
[**2124-6-28**] 06:35AM BLOOD ALT-6 AST-11 AlkPhos-107 TotBili-0.4
[**2124-6-27**] 02:59AM BLOOD Phenyto-11.1
[**2124-6-28**] 06:35AM BLOOD Phenyto-10.3
[**2124-6-25**] 11:40PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2124-6-26**] 01:25AM BLOOD Type-ART Temp-37.6 Rates-/14 Tidal V-500
PEEP-5 FiO2-100 pO2-503* pCO2-32* pH-7.30* calTCO2-16* Base
XS--9 AADO2-195 REQ O2-40 -ASSIST/CON Intubat-INTUBATED
[**2124-6-25**] 11:49PM BLOOD Glucose-216* Lactate-2.8* Na-140 K-4.0
Cl-113* calHCO3-16*
.
Discharge labs:

.
.Urine:
[**2124-6-26**] 01:00AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.010
[**2124-6-26**] 01:00AM URINE Blood-TR Nitrite-NEG Protein-100
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG
[**2124-6-26**] 01:00AM URINE RBC-1 WBC-3 Bacteri-MOD Yeast-NONE Epi-0
[**2124-6-26**] 01:00AM URINE Mucous-RARE
[**2124-6-26**] 01:00AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG mthdone-NEG
.
Microbiology:
[**2124-6-29**]	SEROLOGY/BLOOD	RAPID PLASMA REAGIN
TEST-PENDING	[**2124-6-26**]	MRSA SCREEN	MRSA
SCREEN-Negative
[**2124-6-26**]	URINE	URINE CULTURE-Negative
[**2124-6-25**]	BLOOD CULTURE	Blood Culture, Routine-No
growth to date
[**2124-6-25**]	BLOOD CULTURE	Blood Culture, Routine-No
growth to date
.
[**Hospital3 17163**]
LP 2 RBCs, 26 WBC with 10 lymphocytes and 16 monocytes, with no
growth on CSF culture.
HSV PCR negtive at <80 copies


Brief Hospital Course:
Primary diagnosis:
1) Seizures likely secondary to left parietal brain lesion
2) Left parietal brain lesion ? subacute arterial/venous infarct
vs other cause following head injury
.
Secondary diagnoses:
Difficult to control hypertension ? renal artery stenosis
Acute renal failure which settled
.
.
.
64 yo M with h/o NIDDM, HTN, HL, with heavy cannabis use who
presents with 2 seizures of unknown etiology. Patient remembers
fall and head injury 10 days prior to presentation but only
visible injury was to his foot. Initially had N/V and abdominal
pain 1 day prior to presentation, went to [**Hospital3 **] where
workup was negative. On the day of presentation patient felt
unwell - diaphoretic and chilled and was less responsive -
staring and roaming eyes. Had GTC seizure in ambulance and had
further seizure in [**Hospital3 17162**] ED with R gaze deviation. He was
intubated for airway protection and started on propofol. Head CT
showed chronic L parietal infarct, C-spine was normal, and CT
C/A/P was unrevealing save bilateral renal masses whcih were
likely cysts. LP was significant for 26 WBC (10 L, 16 MONOs), 2
RBCs with normal protein and glucose (opening pressure not
reported). Patient was treated with Dexamethasone 10 mg,
acyclovir, CTX, ampicillin, and vanco and was transferred to
[**Hospital1 18**]. There was no growth on CSF culture and HSV PCR negative
and antibiotics and then acyclovir were stopped. The small
number of cells was felt not to be encephalitis and could
represent post-stroke and seizure changes. Patient was
transferred to the neuro ICU at [**Hospital1 18**]. Patient was started on IV
fosphenytoin in the ICU and transitioned to po phenytoin with no
further seizures. MRI showed a small focus of altered signal
intensity in the left parietal lobe with areas of
mineralization, cortical thickening, edema and gyriform
enhancement with a smaller focus more posteriorly in the left
post parietal/occipital lobe junction and was felt to be venous
vs subacute arterial infarct although diagnosis is uncertain and
will have to be monitored with repeat interval scan. EEG showed
diffuse slowing consistent with propofol use but no seizure
activity.

Patient was successfully extubated and transferred to the
neurology floor. Neurological examination on transfer was in
keeping with mild encephalopathy was nonfocal and there was poor
memory and attention which improved and was felt due to
post-ictal state. Patient had a markedly abnormal lipid panel
and was started on atorvastatin. CTA showed no evidence of AVM,
or any other vascular anomalies and stable hypodensity in left
parietal and left occipital lobe with mild atherosclerotic
plaquing in the left carotid artery at the origin of the left
internal carotid artery which was not hemodynamically
significant. BP was very high and difficult to control requiring
PRN medications and these was evidence of right kidney smaller
than left on renal ultrasound suggesting possible renal artery
stenosis. There were also multile bilateral cysts without a
solid component. Will need o/p follow-up with a renal doppler
U/S. On discharge, phenytoin was stopped after starting
levetiracetam 1g [**Hospital1 **] [**6-30**]. Patient has neurology follow-up and
should book a repeat MRI scan with contrast on this day to
monitor and further characterise this lesion.

.
.
# Left parietal lesion of unclear etiology and seizures: Patient
presented with 2 GTC seizures 10 days post fall with head injury
per patient and patient was intubated for airway protection. CSF
showed 26 WBC (10 L, 16 MONOs), 2 RBCs with normal protein and
glucose. No growth on culture and HSV PCR was negative. CT torso
was apparently negative at the OSH. MRI showed a small focus of
altered signal intensity in the left parietal lobe with areas of
mineralization, cortical thickening, edema and gyriform
enhancement with a smaller focus more posteriorly in the left
post parietal/occipital lobe junction and was felt to be venous
vs subacute arterial infarct although diagnosis is uncertain and
will have to be monitored with repeat interval scan. Patient was
started on IV fosphenytoin in the ICU and was transitioned to po
pheytoin. Patient had no further seizueres. EEG showed diffuse
slowing consistent with propofol use but no seizure activity.
Patient was ecxtubated and transferred to the neuro floor.
Neurological examination ontransfer was nonfocal and there is
poor memory and attention.
Risk factors were addressed and HbA1c was 6.5%. Patient had a
markedly abnormal lipid profile with Chol 338 TGCs 258 LDL 244
and was started on atorvastatin 20mg. Echo cardiogram showed no
cardiac cuase for stroke with no ASD/VSD or PFO. EF was 60%.
Ascending aorta was mildly dilated at 3.6cm and no vegetations
or significant valvular defects were seen.
Patient was initially mildly encephalopathic and was disoriented
with mild R asterixis. Aseriixis resolved and patient cleared
with residal poor memory. RPR was non-raective. CTA to evaluate
intra/extracranial vessels showed no evidence of AVM, or any
other vascular anomalies and stable hypodensity in left parietal
and left occipital lobe with mild atherosclerotic plaquing in
the left carotid artery at the origin of the left internal
carotid artery which was not hemodynamically significant.
Patient noted night sweats and cough past few weeks. CT-CAP at
OSH showed clear lungs per report and showed bilateral renal
masses which likely reprsent cyst. Renal U/S showed multiple
bilateral renal cysts withoutr solid component and R kidney
smaller than L suggesting possible renal artery stenosis. Raised
inflamatory markers ESR 37 CRP 72. On discharge, phenytoin was
stopped after starting levetiracetam 1g [**Hospital1 **] [**6-30**].
Patient has neurology follow-up on [**2124-8-15**] and should book a
repeat MRI scan with contrast on this day to monitor and further
characterise this lesion.
.
# HLD: Significantly elevated lipids Chol 338 TGCs 258 LDL244.
We started atorvastatin 20mg.
.
# Very difficult to control HTN: HTN and SBP often spiking to
180s-200s and very difficult to control requiring frequent PRNs.
This also limited PT eval as BP roise to max SBP 220mmHg on
exertion. On renal ultrasound, right kidney was smaller than
left suggesting possible renal artery stenosis so ACEI stopped.
Will need o/p follow-up with a renal doppler U/S. We started
hydrochlorothiazide on the day of discharge. Patient will need
PCP [**Name9 (PRE) 702**] for his HTN.
.
# ENDO: T2DM. Hold po DM meds. HbA1c 6.5%. Patient was treated
with HISS in house and restarted on home DM medications on
discharge.
.
# RENAL: Mild Cr elevation which is iproving 1.5->1.3. Improved
to 1.2. Bilateral renal "masses" present on OSH CT-CAP whcih
were likely cysts. Renal U/S showed multiple bilateral renal
cysts withoutr solid component and R kidney smaller than L
suggesting possible renal artery stenosis. Will need o/p
follow-up with a renal doppler U/S.
.
# ID: 2x seizures and left hemisphere lesions as above.LP was
significant for 26 WBC (10 L, 16 MONOs), 2 RBCs with normal
protein and glucose (opening pressure not reported). The pt then
received Decadon 10 mg, acyclovir, CTX, amp, and vanco. No
growth on CSF culture. HSV PCR negative. Abx and antivirals were
stopped. Afebrile and initial encephalopathy cleared.

.
# Right arm swollen with small blisters. Right arm swollen and
slightly hotter than left. This was felt related to dependent
edema and IVs post ICU stay. Improved.
.
.
FEN: Regular/thin liquids. Replete lytes PRN.
.
# Code status: Full code
# Contacts: son [**Name (NI) **] [**Telephone/Fax (1) 89085**] (wants to be there for
extubation), mother of [**Name (NI) **] ([**Doctor First Name **]) [**Telephone/Fax (1) 89086**], sister
[**Name (NI) 14880**] [**Telephone/Fax (1) 89087**]


Medications on Admission:
ASA 81 mg
sitagliptin 50 mg daily
Venlafaxine 150 mg [**Hospital1 **]
Topamax 200 qhs
glipizide 5 mg daily
metoprolol 25 mg [**Hospital1 **]
amlodipine 5 mg daily
enlapril 5 mg daily
Flomax 0.4 mg qhs
vitamin B12
omeprazole 20 mg daily
zolpidem 10 mg qhs


Discharge Medications:
1. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
2. Viitamin B12  Sig: One (1) Tab  once a day.
3. Flomax 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO at bedtime.
4. glipizide 5 mg Tablet Extended Rel 24 hr Sig: One (1) Tablet
Extended Rel 24 hr PO once a day.
5. sitagliptin 50 mg Tablet Sig: One (1) Tablet PO once a day.
6. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
7. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
9. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO three
times a day.
Disp:*90 Tablet(s)* Refills:*0*
10. aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
11. zolpidem 10 mg Tablet Sig: One (1) Tablet PO at bedtime.
12. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
13. venlafaxine 75 mg Tablet Sig: Two (2) Tablet PO twice a day.

14. hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] Home Health Care

Discharge Diagnosis:
Primary diagnosis:
1) Seizures likely secondary to left parietal brain lesion
2) Left parietal brain lesion ? subacute arterial/venous infarct
vs other cause following head injury
.
Secondary diagnoses:
Difficult to control hypertension ? renal artery stenosis
Acute renal failure wich settled


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
It was a pleasure taking care of you during your stay at the
[**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **].

You presented to an outside hospital following two seizures and
had a breathing tube placed as there was concern that you were
protecting your airway and you were transferred to the ICU. You
had a lumbar puncture (spinal tap) which showed evidence of
inflammation and you were briefly treated with antibiotics and
antivirals until spinal fluid cultures and viral studies came
back negative. You were also treated with anti-seizure
medications which were continued and you had no further
seizures. You were transferred to the [**Hospital1 18**].

You had head imaging including MRI which showed a lesion on the
left side of your brain and it is unclear whether this
represents a small stroke which occurred following your fall and
induced your seizures.

You improved although you had limited recollection of the events
which brought you into hospital. You were seen by physical
therapy and you were felt to be unsteady. You had high blood
pressure and we controlled this by adding back your home
medications and increased these. You had a very high blood
cholesterol and you were started on a cholesterol lowering
medication called simvastatin. Your blood pressure was very
difficult to control and this may be due to a narrowing of one
of the arteries supplying your kidney. We adjusted your blood
pressure medications and your blood pressure improved, however
this will need to be monitored by your primary care doctor.

You should book a repeat MRI to happen on the day of your
neurology appointment or the day before to allow results to be
back when you are seen by the neurologist. This is so that we
can monitor your brain lesion which we feel is probably a stroke
but some uncertainty exists as to whether this another
inflammatory process.

Medication changes:
We STARTED Keppra (levetiracetam) 1000mg twice daily for
seizures
We INCREASED aspirin to 325mg daily
We Increased Norvasc to 10mg daily
We Started Hydrocholothiazide 25mg daily
We INCREASED metoprolol to 25mg three times daily
We STOPPED enalapril because of possible kidney artery
narrowing.

YOU NEED TO STOP SMOKING! THIS IS THE BEST THING YOU CAN DO FOR
YOUR HEALTH.  THIS INCLUDES SUBSTANCES OTHER THAN TOBACCO.


Followup Instructions:
Plaese make an appointment to see your PCP for within 1 week on
([**Telephone/Fax (1) 89088**].
.
Please organize a repeat MRI scan for [**2124-8-15**] on the day of
your appointent. Please call [**Telephone/Fax (1) 327**] to book this for
[**2124-8-15**].
.
Department: NEUROLOGY
When: TUESDAY [**2124-8-15**] at 4:00 PM
With: [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**Telephone/Fax (1) 2574**]
Building: [**Hospital6 29**] [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage



Completed by:[**2124-7-1**]
{'Generalized convulsive epilepsy, without mention of intractable epilepsy,Encephalopathy, unspecified,Acute kidney failure, unspecified,Cystic kidney disease, unspecified,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Chronic kidney disease, unspecified,Personal history of traumatic brain injury,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cannabis abuse, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}


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: seizure

PRESENT ILLNESS: Mr. [**Known lastname 11950**] is a 64 yo M with h/o NIDDM, HTN, HL who presents
with new onset seizures.
The pt was feeling unwell with N/V 1 day prior to presentation,
and went to [**Hospital3 **] where workup was negative and he was
D/Ced
home. On the day of presentation, the patient (who lives with
his
son) was fine in the morning. However, in the afternoon he
seemed
diaphoretic and chilled. His son thought he seemed "out of it."
He was focusing on something behind his son rather than making
eye contact, and would answer "I'm ok" at first, but later was
not speaking or responding. His son suggested he lie down, which
he did, and he was rolling back and forth in bed toward and away
from the fan. The son did not notice any facial droop, focal
weakness, or incontinence. He called EMS, who brought patient to
[**Hospital3 **].
The pt reportedly had 1 seizure in the ambulance with rightward
gaze deviation, and received 5 mg Valium. In the ED, the
attending witnessed another GTC with R gaze deviation. The
patient received 2 mg Ativan, 1 g Dilantin. He was intubated for
airway protection and started on propofol. Head CT showed
chronic
L parietal infarct, C-spine was normal, and CT C/A/P was
unrevealing. LP was significant for 26 WBC (10 L, 16 MONOs), 2
RBCs with normal protein and glucose (opening pressure not
reported). The pt then received Decadon 10 mg, acyclovir, CTX,
amp, and vanco.

MEDICAL HISTORY: - NIDDM c/b neuropathy
- HTN
- HL
- GERD

MEDICATION ON ADMISSION: ASA 81 mg
sitagliptin 50 mg daily
Venlafaxine 150 mg [**Hospital1 **]
Topamax 200 qhs
glipizide 5 mg daily
metoprolol 25 mg [**Hospital1 **]
amlodipine 5 mg daily
enlapril 5 mg daily
Flomax 0.4 mg qhs
vitamin B12
omeprazole 20 mg daily
zolpidem 10 mg qhs

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: At admission:
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally
Skin: no rashes or lesions noted.

FAMILY HISTORY: negative for stroke, seizure. + for DM, breast CA

SOCIAL HISTORY: lives with son, recently moved from [**Name (NI) 108**] 6 months
ago to be closer to family. Not married. Retired veteran. Smokes
less than 1pk/day, occasional marijuana, no ETOH or IVDU. Uses
cane to ambulate, independent in ADLs. 

### Response:
{'Generalized convulsive epilepsy, without mention of intractable epilepsy,Encephalopathy, unspecified,Acute kidney failure, unspecified,Cystic kidney disease, unspecified,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Chronic kidney disease, unspecified,Personal history of traumatic brain injury,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cannabis abuse, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}
