CHIEF COMPLAINT: Headache with left hemiparesis

PRESENT ILLNESS: [**Known lastname 91616**] [**Known firstname 91617**] is a 52 yo right handed male who presented to
LGH with progressive left hemiparesis and severe headaches.  His
family states that over the past 2-3 weeks he had been waking up
every morning with a horrible frontal headache over the right
frontal portion of his head. On the morning of [**7-13**], his
daughter reports that he was unable to grasp things in his left
hand. A
head CT per report was concerning MCA infarct on the right side
with uncal herniation and he was intubated for airway protection
with succ./propofol/vecuronium.
On arrival he was sedated and paralyzed, and blood sugar was
~400. Head Ct was reviewed with showed a large right
frontotemporal parietal mass with vasogenic edema and midline
shift of 1cm.  Neurology was consulted and was given 1 g/kg of
mannitol, hyperventilate and repeat scan was recommended. We
asked neurosurgery to be consulted who accepted him for
admission.

MEDICAL HISTORY: HTN
DM
hypercholesterolemia

MEDICATION ON ADMISSION: Amlodipine 10 daily
Lisinopril 40 daily
Simvistatin 20
Lantus
Metformin

ALLERGIES: lisinopril

PHYSICAL EXAM: Vitals: 97.8 72 167/87 18 SpO2 100% 60%FIO2(on vent)
General: intubated, sedated, tooth displaced
HEENT: b/l pterygium in eyes, atraumatic, non-icteric sclera
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: CTAB, no w/c/r
Cardiac: RRR, no murmurs
Abdomen: distended abdomen, no ascites, no Cullen or grey [**Doctor Last Name 4862**]
sign
Extremities: no edema, pulses palpated, no clubbing, cyanosis or
edema
Skin: no rashes or lesions noted.

FAMILY HISTORY: Family Hx:
Mother - cancer - unknown type
Father - MI
kids - healthy

SOCIAL HISTORY: lives in [**Hospital1 487**], MA. self-employed - works mostly as a
cleaner.
non-smoker, minimal EtOH, no illicits
Meningoencephalitis due to toxoplasmosis,Cerebral edema,Acute respiratory failure,Hemiplegia, unspecified, affecting nondominant side,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Long-term (current) use of insulin,Angioneurotic edema, not elsewhere classified,Unspecified accident,Accidents occurring in residential institution,Do not resuscitate status
Toxoplasm meningoenceph,Cerebral edema,Acute respiratry failure,Unsp hmiplga nondmnt sde,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Long-term use of insulin,Angioneurotic edema,Accident NOS,Accid in resident instit,Do not resusctate status
Admission Date:  [**2129-7-13**]              Discharge Date:   [**2129-7-19**]

Date of Birth:  [**2078-4-10**]             Sex:   M

Service: NEUROSURGERY

Allergies:
lisinopril

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Headache with left hemiparesis

Major Surgical or Invasive Procedure:
[**7-18**] R craniectomy resection of mass


History of Present Illness:
[**Known lastname 91616**] [**Known firstname 91617**] is a 52 yo right handed male who presented to
LGH with progressive left hemiparesis and severe headaches.  His
family states that over the past 2-3 weeks he had been waking up
every morning with a horrible frontal headache over the right
frontal portion of his head. On the morning of [**7-13**], his
daughter reports that he was unable to grasp things in his left
hand. A
head CT per report was concerning MCA infarct on the right side
with uncal herniation and he was intubated for airway protection
with succ./propofol/vecuronium.
On arrival he was sedated and paralyzed, and blood sugar was
~400. Head Ct was reviewed with showed a large right
frontotemporal parietal mass with vasogenic edema and midline
shift of 1cm.  Neurology was consulted and was given 1 g/kg of
mannitol, hyperventilate and repeat scan was recommended. We
asked neurosurgery to be consulted who accepted him for
admission.

Review of systems - unable to obtain
intubated


Past Medical History:
HTN
DM
hypercholesterolemia

Social History:
lives in [**Hospital1 487**], MA. self-employed - works mostly as a
cleaner.
non-smoker, minimal EtOH, no illicits

Family History:
Family Hx:
Mother - cancer - unknown type
Father - MI
kids - healthy

Physical Exam:
Vitals: 97.8 72 167/87 18 SpO2 100% 60%FIO2(on vent)
General: intubated, sedated, tooth displaced
HEENT: b/l pterygium in eyes, atraumatic, non-icteric sclera
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: CTAB, no w/c/r
Cardiac: RRR, no murmurs
Abdomen: distended abdomen, no ascites, no Cullen or grey [**Doctor Last Name 4862**]
sign
Extremities: no edema, pulses palpated, no clubbing, cyanosis or
edema
Skin: no rashes or lesions noted.

Neurologic:
GCS E2V1M5 8T
Mental Status: sedated, non-responsive to sternal rub
Cranial Nerves: pupils 2mm b/l and reactive, bilateral pterygium

+ corneals, facial symmetric, + gag, + cough
Motor: normal tone and bulk, Purposeful in all extremities R>L,
some spontaneous movement bilaterally
Reflexes: 2+ UE and LE Babinski is flexor response b/l


Pertinent Results:
[**2129-7-14**] MRA OF THE HEAD:
The head MRA demonstrates no evidence of vascular occlusion or
stenosis. No evidence of an aneurysm greater than 3 mm in size
seen.
IMPRESSION: No vascular occlusion or stenosis is seen on the MRA
of the head.
MRI Brain IMPRESSION: Rim-enhancing lesions in the right
periventricular region adjacent to the anterior [**Doctor Last Name 534**] of the
lateral ventricle and right parietal subcortical region as well
as subtle signal abnormality and enhancement in the right
thalamus. Differential diagnosis includes metastasis versus
lymphoma.  The signal abnormalities on diffusion images in the
right thalamus and periatrial region could be related to
lymphoma or could be due to small infarcts unrelated to the
primary abnormality. Mass effect is seen on the right lateral
ventricle with mild midline shift.

[**2129-7-14**] CT Head: IMPRESSION: Extensive vasogenic edema
throughout the right hemisphere is again seen, without change
since prior study. Masses seen on prior MRI are not well
visualized by CT. Midline shift is unchanged compared to prior
study.

[**2129-7-14**]: CT Torso: IMPRESSION:
1. No evidence of primary malignancy in the chest, abdomen, or
pelvis.
2. Bibasilar opacities may be representative of infection,
likely from
aspiration in the appropriate clinical setting. Clinical
correlation is
recommended.


Brief Hospital Course:
Mr. [**Known lastname 91616**] was admitted to the ICU, intubated at OSH, with
frequent neuro checks, blood pressure control less than 140,
Mannitol Q4 hours for significant edema and midline shift with
frequent Serum OSM and Na checks. In addition he was started on
Dexamethasone for cerebral edema and dilantin for seizure
prophylaxis.

on [**7-14**] he underwent an MRI/A that demonstrated ring enhancing
lesions in the right parietal lobe and abutting the right
lateral ventricle.  CT torso demonstrated no evidence of
malignancy. He was transitioned to Mannitol 25 Q6 hrs with Q6
hour labs. He was successfully extubated overnight. On [**7-16**] an
LP was attempted but was unsuccesfull as he would not cooperate
with exam. On [**7-17**] he developed speech difficulty and tongue
swelling. He was given benadryl and IV decadron with no relief.
He was emergently intubated. On [**7-17**] a successfull LP was
obtained and CSF was sent out for numerous infectious
examinations. He was on paralytics but he had no pupillary
response and then his exam remained poor when off sedation. On
[**7-18**], he was take to the OR for a decompressive craniectomy. He
was left intubated and transfered back to the ICU. Post-op
imaging showed significant cerrebral edema. We continued
treating him with Decadron and Mannitol however NA increased to
162 and this had to be held. He had a perfusion study on [**7-18**]
and results were available on [**7-19**] showing brain death.

Patient expired on the evening of [**2129-7-19**].

Medications on Admission:
Amlodipine 10 daily
Lisinopril 40 daily
Simvistatin 20
Lantus
Metformin


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
right frontal and frontoparietal lesion
Cerebral edema with herniation
Angioedema
Respiratory failure


Discharge Condition:
expired


Discharge Instructions:
none

Followup Instructions:
none



Completed by:[**2129-7-19**]

Name:  [**Known lastname 14427**],[**Known firstname 14428**]               Unit No:   [**Numeric Identifier 14429**]

Admission Date:  [**2129-7-13**]              Discharge Date:   [**2129-7-19**]

Date of Birth:  [**2078-4-10**]             Sex:   M

Service: NEUROSURGERY

Allergies:
lisinopril

Attending:[**First Name3 (LF) 599**]
Addendum:
This patient had a pathologic tissue diagnosis of Toxoplasmosis
Cerebritis which contributed to his passing.


Discharge Disposition:
Expired

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 603**] MD [**MD Number(2) 604**]

Completed by:[**2129-8-31**]
{'Meningoencephalitis due to toxoplasmosis,Cerebral edema,Acute respiratory failure,Hemiplegia, unspecified, affecting nondominant side,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Long-term (current) use of insulin,Angioneurotic edema, not elsewhere classified,Unspecified accident,Accidents occurring in residential institution,Do not resuscitate status'}


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 with left hemiparesis

PRESENT ILLNESS: [**Known lastname 91616**] [**Known firstname 91617**] is a 52 yo right handed male who presented to
LGH with progressive left hemiparesis and severe headaches.  His
family states that over the past 2-3 weeks he had been waking up
every morning with a horrible frontal headache over the right
frontal portion of his head. On the morning of [**7-13**], his
daughter reports that he was unable to grasp things in his left
hand. A
head CT per report was concerning MCA infarct on the right side
with uncal herniation and he was intubated for airway protection
with succ./propofol/vecuronium.
On arrival he was sedated and paralyzed, and blood sugar was
~400. Head Ct was reviewed with showed a large right
frontotemporal parietal mass with vasogenic edema and midline
shift of 1cm.  Neurology was consulted and was given 1 g/kg of
mannitol, hyperventilate and repeat scan was recommended. We
asked neurosurgery to be consulted who accepted him for
admission.

MEDICAL HISTORY: HTN
DM
hypercholesterolemia

MEDICATION ON ADMISSION: Amlodipine 10 daily
Lisinopril 40 daily
Simvistatin 20
Lantus
Metformin

ALLERGIES: lisinopril

PHYSICAL EXAM: Vitals: 97.8 72 167/87 18 SpO2 100% 60%FIO2(on vent)
General: intubated, sedated, tooth displaced
HEENT: b/l pterygium in eyes, atraumatic, non-icteric sclera
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: CTAB, no w/c/r
Cardiac: RRR, no murmurs
Abdomen: distended abdomen, no ascites, no Cullen or grey [**Doctor Last Name 4862**]
sign
Extremities: no edema, pulses palpated, no clubbing, cyanosis or
edema
Skin: no rashes or lesions noted.

FAMILY HISTORY: Family Hx:
Mother - cancer - unknown type
Father - MI
kids - healthy

SOCIAL HISTORY: lives in [**Hospital1 487**], MA. self-employed - works mostly as a
cleaner.
non-smoker, minimal EtOH, no illicits 

### Response:
{'Meningoencephalitis due to toxoplasmosis,Cerebral edema,Acute respiratory failure,Hemiplegia, unspecified, affecting nondominant side,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Long-term (current) use of insulin,Angioneurotic edema, not elsewhere classified,Unspecified accident,Accidents occurring in residential institution,Do not resuscitate status'}
