CHIEF COMPLAINT: Seizure/Status Epilepticus

PRESENT ILLNESS: 34 yo M with PMH head trauma in [**2110**] and chronic headaches,
no hx seizures, who was transferred here after having had
several
seizures and being intubated. History was obtained with his
mother [**Name (NI) **] and [**Name (NI) **] physician from [**Hospital3 3583**]. As per
his
mother last week patient was complaining of more severe
headaches
and having chills. There is no PMH of seizures. Last wednesday,
as per his mother, his girlfriend found him unresponsive and
with
starring eyes for about 5 min, having become confused afterwards
and he had a tongue bite but no urinary or bowel incontinence.
He
went to [**Hospital 8125**] hospital where a CT head did not show any acute
process, he started to be treated for pneumonia with levoquin
and
he left AMA. This morning at 8am his girlfriend found him less
responsive with eyes rolling and rigidity of extremeties with no
clear shaking for 3 min, as per her, he was confused for 20min
afterwards. He had another event at 9:30am and he was taken to
[**Hospital3 3583**]. As per ED physician there he had 3 GTC seizures
lasting about 3min; he vomited; became extremely agitated and
aggressive and was intubated. He was loaded with keppra 1500mg
and received totally 8mg ativan, fentanyl, vecuronium and
propofol and he was transferred here by [**Location (un) **]. In ED he was
given ceftriaxone 2g, vancomycin 1g, and decadron 10mg.

MEDICAL HISTORY: Head trauma in [**2110**] after having falling down the stairs
Headaches

MEDICATION ON ADMISSION: Trazedone (unknown dose)

ALLERGIES: Haldol / Claritin

PHYSICAL EXAM: T-97.8 BP-114/81 HR-76 RR-16 100% O2Sat
Gen: intubated
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, no rigidity, no carotid or
vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Mother has DM and HTN. No family hx of seizures

SOCIAL HISTORY: He lives with his girlfriend; he is currently unemployed (used
to work as a cook), he smokes a pack of cigarettes every 2 days,
history of alcohol abuse and marijuana.
Grand mal status,Cerebral artery occlusion, unspecified without mention of cerebral infarction,Alcohol abuse, unspecified,Late effect of intracranial injury without mention of skull fracture,Late effects of accidental fall
Grand mal status,Crbl art oc NOS wo infrc,Alcohol abuse-unspec,Lt eff intracranial inj,Late eff accidental fall
Admission Date:  [**2116-8-29**]              Discharge Date:   [**2116-9-2**]

Date of Birth:  [**2082-4-5**]             Sex:   M

Service: NEUROLOGY

Allergies:
Haldol / Claritin

Attending:[**First Name3 (LF) 5167**]
Chief Complaint:
Seizure/Status Epilepticus

Major Surgical or Invasive Procedure:
Intubation, Lumbar Puncture

History of Present Illness:
34 yo M with PMH head trauma in [**2110**] and chronic headaches,
no hx seizures, who was transferred here after having had
several
seizures and being intubated. History was obtained with his
mother [**Name (NI) **] and [**Name (NI) **] physician from [**Hospital3 3583**]. As per
his
mother last week patient was complaining of more severe
headaches
and having chills. There is no PMH of seizures. Last wednesday,
as per his mother, his girlfriend found him unresponsive and
with
starring eyes for about 5 min, having become confused afterwards
and he had a tongue bite but no urinary or bowel incontinence.
He
went to [**Hospital 8125**] hospital where a CT head did not show any acute
process, he started to be treated for pneumonia with levoquin
and
he left AMA. This morning at 8am his girlfriend found him less
responsive with eyes rolling and rigidity of extremeties with no
clear shaking for 3 min, as per her, he was confused for 20min
afterwards. He had another event at 9:30am and he was taken to
[**Hospital3 3583**]. As per ED physician there he had 3 GTC seizures
lasting about 3min; he vomited; became extremely agitated and
aggressive and was intubated. He was loaded with keppra 1500mg
and received totally 8mg ativan, fentanyl, vecuronium and
propofol and he was transferred here by [**Location (un) **]. In ED he was
given ceftriaxone 2g, vancomycin 1g, and decadron 10mg.

ROS: As per the mother he had been complaining of chills last
week and more severe headaches.

Past Medical History:
Head trauma in [**2110**] after having falling down the stairs
Headaches

Social History:
He lives with his girlfriend; he is currently unemployed (used
to work as a cook), he smokes a pack of cigarettes every 2 days,
history of alcohol abuse and marijuana.


Family History:
Mother has DM and HTN. No family hx of seizures


Physical Exam:
T-97.8 BP-114/81 HR-76 RR-16 100% O2Sat
Gen: intubated
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, no rigidity, no carotid or
vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

Neurologic examination:
Mental status: intubated; when reduced propofol he started to
move all extremities spontaneously symmetrically and tried to
pull out the tube. He did not follow any verbal command.


Cranial Nerves:
Pupils equally round and reactive to light, 2.5 to 1.5 mm
bilaterally. No abnormality on fundi was observed, although
limited exam. Doll's and corneal were normal. Normal Gag reflex.

Facial movement symmetric.  Hearing intact to finger rub
bilaterally. Tongue midline, movements intact

Motor:
Normal bulk bilaterally. Tone normal. No observed myoclonus or
tremor
When reduced propofol he started to move all extremities
spontaneously and tried to pull out the tube. He could localize
pain on both sides. He flexed both legs symmetrically

Sensation: symmetric retraction of all extremeties to noxious
stimuli

Reflexes: B T Br Pa Pl
Right     1 1  1  1  1
Left      1 1  1  1  1
Toes were mute bilaterally.

Coordination: not examined

Gait: not examined.


Pertinent Results:
[**2116-8-29**] 04:25PM URINE
URIC ACID-FEW
RBC-[**3-5**]* WBC-0-2 BACTERIA-FEW YEAST-NONE EPI-0-2
BOOD-LG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG
BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG
COLOR-Yellow APPEAR-Hazy SP [**Last Name (un) 155**]-1.018
bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG
mthdone-NEG
FIBRINOGE-258
PT-10.7 PTT-23.4 INR(PT)-0.9
PLT COUNT-293

[**2116-8-29**] 04:25PM
WBC-13.2* RBC-4.47* HGB-13.2* HCT-39.7* MCV-89 MCH-29.6
MCHC-33.3 RDW-12.9
ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG
tricyclic-NEG
ALBUMIN-3.9
CK-MB-8
TropnT-0.01
LIPASE-16
ALT(SGPT)-35 AST(SGOT)-60* LD(LDH)-331* C
K(CPK)-2260* ALK PHOS-63 TOT BILI-0.2
UREA N-15 CREAT-0.9
freeCa-1.12
GLUCOSE-87 LACTATE-1.4 NA+-140 K+-3.9 CL--106 TCO2-22
TYPE-ART TEMP-37.6 PO2-339* PCO2-42 PH-7.36 TOTAL CO2-25 BASE
XS--1

[**2116-8-29**] 07:45PM
CEREBROSPINAL FLUID (CSF)  WBC-2 RBC-0 POLYS-1 LYMPHS-54
MONOS-45
{CSF)  PROTEIN-30 GLUCOSE-74

[**2116-8-29**] 11:25PM   LACTATE-1.4
[**2116-8-29**] 11:25PM   TYPE-ART PO2-114* PCO2-43 PH-7.34* TOTAL
CO2-24

ECG Study Date of [**2116-8-29**]  4:34:00 PM
Sinus rhythm. One to two millimeters of J point elevation in
leads V2-V6
and, to a lesser degree in leads I and II, are consistent with
early
repolarization variant. Tracing is within normal limits. No
previous tracing  available for comparison.
  Intervals Axes
Rate PR QRS QT/QTc P QRS T
73 154 96 376/398 55 64 42

CT HEAD W/O CONTRAST Study Date of [**2116-8-29**] 5:29 PM
IMPRESSION:
1. Area of encephalomalacia in the left frontal lobe, possibly
post-traumatic in etiology.
2. Mucosal thickening in the ethmoid, maxillary and sphenoid
sinuses, likely due to ongoing inflammation.
3. No intracranial hemorrhage.




Brief Hospital Course:
Mr. [**Known lastname 58784**] is a 34 year old man with a history of traumatic
brain injury and ethanol abuse (last use [**6-9**]) who presented as
a transfer from [**Hospital3 3583**] on [**8-29**] in the setting of status
epilepticus.

The patient had been intubated prior to his transfer to [**Hospital1 18**].
On arrival, he was
given ceftriaxone 2g, vancomycin 1g, and decadron 10mg for
possible infectious eitology of seizures.  In addition, he was
loaded with Keppra.  LP was performed and was without evidence
of infection; antibiotics were discontinued.  CT scan here was
notable for an area of encephalomalacia in the right frontal
lobe which was suspected to correlated with the patient's old
head injury.  He was extubated on hospital day 2.  The patient
was continued on Keprra 1500mg [**Hospital1 **] while inpatient, and had no
further clinical seizures.  Long-term EEG monitoring, however
demonstrated subclinical seizure in the left frontal region
during sleep.  The patient requested not to remain inpatient
after this was discovered; therefore his Keppra dose was
increased (from 1500mg PO BID) to 1500mg PO qam and 2000mg PO
qpm at the time of discharge, and he was started on a 9-day
ativan taper as a bridge.  He received instructions regarding
seizure precautions.

Medications on Admission:
Trazedone (unknown dose)

Discharge Medications:
1. Levetiracetam 500 mg Tablet Sig: 3 tablets every morning and
4 tablets every evening  PO As directed.
Disp:*210 Tablets* Refills:*2*
2. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO TID for 3 days,
then [**Hospital1 **] for 3 days, then daily for 3 days, then stop.
Disp:*18 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Seizure, likely secondary to encephalomalacia from head injury
in [**2110**].


Discharge Condition:
Stable.  Normal exam.


Discharge Instructions:
You were admitted with a very long seizure called status
epilepticus, which required you to have a breathing tube
temporarily while you were in the ICU.  Your seizures are most
likely due to your prior head injury in [**2110**].  In the hospital
you were started on a medication called Keppra to prevent
further seizures.  On the Keppra, you have not had any seizures
that you notice or we could see (called "clinical seizures").
However, your EEG continues to show brain waves that are
consistent with seizures in your brain that we cannot physically
see (called "subclinical seizures").  To help prevent these
subclinical seizures and decrease your risk for further clinical
seizures, the dose of your Keppra is being increased.  To give
the higher dose time to start working, you should take a
medication called ativan, which will be gradually tapered over
the next 9 days.

Take Keppra consistently to prevent further seizures.  Take
ativan for the next 9 days as directed.  Follow-up with Dr.
[**Last Name (STitle) **] in 2 weeks in epilepsy clinic.

Because of your seizures, you should not participate in
activities that would be dangerous if you have another seizure.
Do not drive for at least 6 months, and follow up with your
doctor before you begin driving again.  Avoid taking baths and
participating in water sports, due to the risk of drowning
during a seizure.  Avoid being in high places that you could
fall from during a seizure.  Avoid operating heavy machinery.

Followup Instructions:
Follow-up with Dr. [**First Name (STitle) 3322**] [**Name (STitle) **] ([**Telephone/Fax (1) 83450**] in 2 weeks in
epilepsy clinic.



Completed by:[**2116-9-2**]
{'Grand mal status,Cerebral artery occlusion, unspecified without mention of cerebral infarction,Alcohol abuse, unspecified,Late effect of intracranial injury without mention of skull fracture,Late effects of accidental fall'}


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/Status Epilepticus

PRESENT ILLNESS: 34 yo M with PMH head trauma in [**2110**] and chronic headaches,
no hx seizures, who was transferred here after having had
several
seizures and being intubated. History was obtained with his
mother [**Name (NI) **] and [**Name (NI) **] physician from [**Hospital3 3583**]. As per
his
mother last week patient was complaining of more severe
headaches
and having chills. There is no PMH of seizures. Last wednesday,
as per his mother, his girlfriend found him unresponsive and
with
starring eyes for about 5 min, having become confused afterwards
and he had a tongue bite but no urinary or bowel incontinence.
He
went to [**Hospital 8125**] hospital where a CT head did not show any acute
process, he started to be treated for pneumonia with levoquin
and
he left AMA. This morning at 8am his girlfriend found him less
responsive with eyes rolling and rigidity of extremeties with no
clear shaking for 3 min, as per her, he was confused for 20min
afterwards. He had another event at 9:30am and he was taken to
[**Hospital3 3583**]. As per ED physician there he had 3 GTC seizures
lasting about 3min; he vomited; became extremely agitated and
aggressive and was intubated. He was loaded with keppra 1500mg
and received totally 8mg ativan, fentanyl, vecuronium and
propofol and he was transferred here by [**Location (un) **]. In ED he was
given ceftriaxone 2g, vancomycin 1g, and decadron 10mg.

MEDICAL HISTORY: Head trauma in [**2110**] after having falling down the stairs
Headaches

MEDICATION ON ADMISSION: Trazedone (unknown dose)

ALLERGIES: Haldol / Claritin

PHYSICAL EXAM: T-97.8 BP-114/81 HR-76 RR-16 100% O2Sat
Gen: intubated
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, no rigidity, no carotid or
vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Mother has DM and HTN. No family hx of seizures

SOCIAL HISTORY: He lives with his girlfriend; he is currently unemployed (used
to work as a cook), he smokes a pack of cigarettes every 2 days,
history of alcohol abuse and marijuana. 

### Response:
{'Grand mal status,Cerebral artery occlusion, unspecified without mention of cerebral infarction,Alcohol abuse, unspecified,Late effect of intracranial injury without mention of skull fracture,Late effects of accidental fall'}
