CHIEF COMPLAINT: [**3-4**] wk feeling unsteady

PRESENT ILLNESS: Patient is a 80 yo man with PMH of HTN, hyperlipid, h/o
afib, osteoporosis, DM2, low testosterone, prostate ca s/p
radiation who is transferred from [**Hospital3 **] with a necrotic brain
lesion in the left parietal/occipital area. Reports that he went
to his PCP recently with 3-4 weeks of spells of unsteadiness. He
describes it as feeling as if he is going to tip over. There is
no dizziness or vertigo with this.  His PCP ordered the CT and
he
was admitted for further work up including a non contrast MRI.
Notes mention both primary and secondary as possibilities, but
there is no official report.  CT torso mentioned as negative but
no official repport.

MEDICAL HISTORY: -HTN
-hyperlipid
-h/o afib
-osteoporosis
-DM2
-low testosterone
-prostate ca s/p radiation
-chronic dry eyes.

MEDICATION ON ADMISSION: Vytorin [**10-20**] daily
Januvia 100 daily
Miacalcin nasal spral 200 IU alternating each nostril QOD
Androgel 5% 2 pumps daily, shoulders and chest
Protonix 40mg PO BID
Oscal with Vit D 500 [**Hospital1 **]
Diovan 160 daily
Rythmol SR 225 Po BID
Astelin [**Hospital1 **]
Keppra 500 [**Hospital1 **]
Decadron 4mg IV or PO Q6hrs
RISS

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: T- 98.0   BP- 176/80  HR- 80  RR- 12  O2Sat  97 RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple, 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: Father died at 78 and mother in 90s both of MI.

SOCIAL HISTORY: Pt is a retired school superintendent. Pt quit smoking 40 [**Month/Year (2) 1686**]
ago, reports drinking 6 [**Last Name (un) 75470**]/week.  Pt lives alone since
wife died 2 [**Name2 (NI) 1686**] ago.  Daughter lives on [**Location (un) 945**] and son lives
in [**Name (NI) **].
Malignant neoplasm of parietal lobe,Hemiplegia, unspecified, affecting unspecified side,Hyposmolality and/or hyponatremia,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoporosis, unspecified,Tear film insufficiency, unspecified,Personal history of malignant neoplasm of prostate,Other postprocedural status,Personal history of tobacco use
Mal neo parietal lobe,Unsp hemiplga unspf side,Hyposmolality,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Osteoporosis NOS,Tear film insuffic NOS,Hx-prostatic malignancy,Post-proc states NEC,History of tobacco use
Admission Date:  [**2198-12-5**]              Discharge Date:   [**2198-12-18**]

Date of Birth:  [**2118-7-10**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 1854**]
Chief Complaint:
[**3-4**] wk feeling unsteady

Major Surgical or Invasive Procedure:
[**12-7**] Brain Biopsy
[**12-13**] Left sided craniotomy


History of Present Illness:
Patient is a 80 yo man with PMH of HTN, hyperlipid, h/o
afib, osteoporosis, DM2, low testosterone, prostate ca s/p
radiation who is transferred from [**Hospital3 **] with a necrotic brain
lesion in the left parietal/occipital area. Reports that he went
to his PCP recently with 3-4 weeks of spells of unsteadiness. He
describes it as feeling as if he is going to tip over. There is
no dizziness or vertigo with this.  His PCP ordered the CT and
he
was admitted for further work up including a non contrast MRI.
Notes mention both primary and secondary as possibilities, but
there is no official report.  CT torso mentioned as negative but
no official repport.

ROS: Denies HA, fever, chills sweats.  Reports that he has had
[**12-15**] lb planned wt loss over 6 mo with diet/excercise.  He is
unsure if his vision has changed, but poor at baseline.  No N/V,
vertigo or bladder or bowel changes.  Small cough which is new
and dry.


Past Medical History:
-HTN
-hyperlipid
-h/o afib
-osteoporosis
-DM2
-low testosterone
-prostate ca s/p radiation
-chronic dry eyes.


Social History:
Pt is a retired school superintendent. Pt quit smoking 40 [**Month/Year (2) 1686**]
ago, reports drinking 6 [**Last Name (un) 75470**]/week.  Pt lives alone since
wife died 2 [**Name2 (NI) 1686**] ago.  Daughter lives on [**Location (un) 945**] and son lives
in [**Name (NI) **].


Family History:
Father died at 78 and mother in 90s both of MI.


Physical Exam:
T- 98.0   BP- 176/80  HR- 80  RR- 12  O2Sat  97 RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple, 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: Awake and alert, cooperative with exam, normal
affect.  Oriented to person, place, and date.  Attentive, says
[**Doctor Last Name 1841**] backwards.  Speech is fluent with normal comprehension and
repetition; naming intact. No dysarthria. [**Location (un) **] and writing
intact.  Registers [**3-4**], recalls [**3-4**] in 5 minutes.  No right left
confusion. No evidence of apraxia or neglect.  No agraphesthesia
in left hand.

Cranial Nerves:
Pupils equally round and reactive to light, 3 to 2 mm
bilaterally. Visual fields are full to confrontation. Catarcts
bilaterally left > right.  Unable to visualize disc left but
intact right.  Extraocular movements intact bilaterally, no
nystagmus. Sensation intact V1-V3.  Facial movement symmetric.
Hearing intact to finger rub bilaterally.  Palate elevation
symmetrical.  Sternocleidomastoid and trapezius normal
bilaterally. Tongue midline, movements intact

Motor:
Normal bulk bilaterally. Tone normal. No observed myoclonus or
tremor

  [**Doctor First Name **] Tri [**Hospital1 **]  WF WE FE FF  IP  H  Q DF PF TE TF
R  5   5   5  5  5  5  5   5   5  5  5  5  5  5
L  5   5   5  5  5  5  5   5   5  5  5  5  5  5

Sensation: Intact to light touch, cold, vibration throughout. No
extinction to DSS on hands, but extinguishes right foot
consistently.

Reflexes:
+2 and symmetric throughout.
Toes down right and up left (?)

Coordination: finger-nose-finger normal, heel to shin normal,
RAMs normal.

Gait: Narrow based, steady.

Romberg: retropulses


Pertinent Results:
   RADIOLOGY  Final Report

MR HEAD W & W/O CONTRAST  [**2198-12-14**] 7:37 PM

MR HEAD W & W/O CONTRAST

Reason: follow up on postop residual tumor. please do before
midnigh

[**Hospital 93**] MEDICAL CONDITION:
80 year old man with s/p craniotomy for tumor resection.
REASON FOR THIS EXAMINATION:
follow up on postop residual tumor. please do before midnight
[**2198-12-14**].
CONTRAINDICATIONS for IV CONTRAST: None.

EXAM: MRI brain.

CLINICAL INFORMATION: Patient status post craniotomy for tumor
resection for postoperative evaluation.

TECHNIQUE: T1 sagittal and axial and FLAIR T2 susceptibility and
diffusion axial images of the brain were acquired before
gadolinium. T1 sagittal, axial and coronal images were obtained
following gadolinium. Comparison was made with the previous
study of [**2198-12-13**].

FINDINGS: Since the previous study, the patient has undergone
resection of enhancing brain lesion in the left parietal
convexity region. Small amount of blood products is seen in this
region with surrounding edema. Following gadolinium, enhancement
is seen along the medial margin of the resection site as well as
inferior margin of the resection site indicating some residual
enhancement. There is also evidence of small area of slow
diffusion seen adjacent to the surgical site which could be
related to surgery. There is pneumocephalus identified. There is
no midline shift or hydrocephalus seen. There is moderate brain
atrophy.

IMPRESSION: Status post resection of the left parietal convexity
enhancing intra-axial brain lesion. Small amount of residual
enhancement is seen immediately and inferior to the resection
site. No large hematoma seen, midline shift or hydrocephalus
identified. No change in the surrounding edema noted.

DR. [**First Name (STitle) 3905**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3906**]
Approved: SAT [**2198-12-15**] 5:38 PM



RADIOLOGY  Final Report

MR HEAD W/ CONTRAST  [**2198-12-13**] 5:39 AM

MR HEAD W/ CONTRAST

Reason: pre-op for tumor resection, please do at 5:00 am on
[**2198-12-13**]
Contrast: MAGNEVIST

[**Hospital 93**] MEDICAL CONDITION:
80 year old man brain tumor
REASON FOR THIS EXAMINATION:
pre-op for tumor resection, please do at 6:00 am on [**2198-12-13**],
prior to OR time
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: Brain tumor, preoperative for tumor resection.

COMPARISON: MRI head dated [**2198-12-7**].

TECHNIQUE: Multiplanar T1- post-gadolinium images were obtained
including axial MP-RAGE images.

MRI HEAD WITH CONTRAST: Enhancing peripheral mass in the left
posterior parietal lobe is again demonstrated and unchanged
compared to [**2198-12-7**]. Surrounding signal abnormality on
T1-weighted images is also again demonstrated and not
significantly changed. Ventricles are stable in size. No other
enhancing lesions within the brain are seen.

IMPRESSION: Enhancing left parietal mass without significant
change compared [**2198-12-7**].

The study and the report were reviewed by the staff radiologist.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) 7415**]
Approved: SAT [**2198-12-15**] 9:10 PM



   RADIOLOGY  Final Report

CT HEAD W/O CONTRAST  [**2198-12-13**] 6:39 PM

CT HEAD W/O CONTRAST

Reason: rule out postop ICH. please do before 7pm [**12-13**].

[**Hospital 93**] MEDICAL CONDITION:
80 year old man with s/p craniotomy for tumor resection.
REASON FOR THIS EXAMINATION:
rule out postop ICH. please do before 7pm [**12-13**].
CONTRAINDICATIONS for IV CONTRAST: None.

HISTORY: Status post left parietal lobe tumor resection.
Evaluate for postoperative hemorrhage.

Comparison is made to [**2198-12-13**] MRI and [**2198-12-8**]
head CT.

NON-CONTRAST HEAD CT.

FINDINGS: There is expected air within the left parietal
surgical bed and expected postoperative pneumocephalus and
adjacent subcutaneous emphysema and swelling adjacent to the
high right parietal craniotomy site. No postoperative
intraparenchymal or extra-axial hemorrhage is identified.
Stable-appearing vasogenic edema within the left parietal lobe.
The appearance of the head CT is otherwise unchanged with stable
mild mucosal thickening within the right maxillary sinus.

IMPRESSION:

Expected postoperative changes with no evidence of hemorrhage.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
DR. [**First Name8 (NamePattern2) 11136**] [**Last Name (NamePattern1) 11137**]
Approved: FRI [**2198-12-14**] 5:52 PM



Cardiology Report ECG Study Date of [**2198-12-8**]  1:59:38 AM


Probable idioventricular rhythm with prolonged QTc interval at a
rate
of 56 beats per minute. Compared to tracing #3 idioventricular
rhythm is now
evident. QTc interval is more polonged. Clinical correlation is
suggested.
TRACING #4


Read by: [**Last Name (LF) **],[**First Name3 (LF) **] S.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
56 0 178 514/507 0 -42 114

RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2198-12-6**] 8:46 AM

CHEST (PA & LAT)

Reason: please do in AM.man with new brain mass

[**Hospital 93**] MEDICAL CONDITION:
80 year old man with new brain mass
REASON FOR THIS EXAMINATION:
please do in AM.man with new brain mass
HISTORY: An 80-year-old male with new brain mass.

CHEST, PA AND LATERAL: There are no prior studies for
comparison. Heart size is normal. The hilar and mediastinal
contours are normal. Lungs are clear. There is a tiny 2-mm
rounded opacity projecting over the left second anterior rib,
likely represents a vessel. No pleural effusions are seen.
Fracture deformities of the right fourth, fifth, and sixth
posterior ribs are seen. No pneumothorax identified.

IMPRESSION: No evidence of intrathoracic malignancy.

jr
The study and the report were reviewed by the staff radiologist.
DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
DR. [**First Name (STitle) 3901**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3902**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Approved: FRI [**2198-12-7**] 4:33 PM
Test Name Value Units Reference Range
[**2198-12-16**] 06:25AM
COMPLETE BLOOD COUNT
White Blood Cells 11.6* K/uL 4.0 - 11.0
  PERFORMED AT WEST STAT LAB
Red Blood Cells 4.49* m/uL 4.6 - 6.2
  PERFORMED AT WEST STAT LAB
Hemoglobin 14.1 g/dL 14.0 - 18.0
  PERFORMED AT WEST STAT LAB
Hematocrit 42.5 % 40 - 52
  PERFORMED AT WEST STAT LAB
MCV 95 fL 82 - 98
  PERFORMED AT WEST STAT LAB
MCH 31.5 pg 27 - 32
  PERFORMED AT WEST STAT LAB
MCHC 33.3 % 31 - 35
  PERFORMED AT WEST STAT LAB
RDW 13.7 % 10.5 - 15.5
BASIC COAGULATION (PT, PTT, PLT, INR)
Platelet Count 142* K/uL 150 - 440
  PERFORMED AT WEST STAT LAB

Test Name Value Units Reference Range
[**2198-12-16**] 06:25AM
RENAL & GLUCOSE
Glucose 127* mg/dL 70 - 105
  PERFORMED AT WEST STAT LAB
Urea Nitrogen 36* mg/dL 6 - 20
  PERFORMED AT WEST STAT LAB
Creatinine 0.9 mg/dL 0.5 - 1.2
  PERFORMED AT WEST STAT LAB
Sodium 140 mEq/L 133 - 145
  PERFORMED AT WEST STAT LAB
Potassium 4.8 mEq/L 3.3 - 5.1
  PERFORMED AT WEST STAT LAB
Chloride 101 mEq/L 96 - 108
  PERFORMED AT WEST STAT LAB
Bicarbonate 31 mEq/L 22 - 32
  PERFORMED AT WEST STAT LAB
Anion Gap 13 mEq/L 8 - 20

Test Name Value Units Reference Range
[**2198-12-6**] 06:40AM
RENAL & GLUCOSE
Glucose 189* mg/dL 70 - 105
  PERFORMED AT WEST STAT LAB
Urea Nitrogen 25* mg/dL 6 - 20
  PERFORMED AT WEST STAT LAB
Creatinine 0.9 mg/dL 0.5 - 1.2
  PERFORMED AT WEST STAT LAB
Sodium 139 mEq/L 133 - 145
  PERFORMED AT WEST STAT LAB
Potassium 3.9 mEq/L 3.3 - 5.1
  PERFORMED AT WEST STAT LAB
Chloride 102 mEq/L 96 - 108
  PERFORMED AT WEST STAT LAB
Bicarbonate 30 mEq/L 22 - 32
  PERFORMED AT WEST STAT LAB
Anion Gap 11 mEq/L 8 - 20
ESTIMATED GFR (MDRD CALCULATION)
Estimated GFR (MDRD equation)
  Using this patient's age, gender, and serum creatinine value
of 0.9,
Estimated GFR = >75 if non African-American (mL/min/1.73 m2)
Estimated GFR = >75 if African-American (mL/min/1.73 m2)
For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73
m2)
GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure
ENZYMES & BILIRUBIN
Alanine Aminotransferase (ALT) 28 IU/L 0 - 40
  PERFORMED AT WEST STAT LAB
Asparate Aminotransferase (AST) 17 IU/L 0 - 40
  PERFORMED AT WEST STAT LAB
Lactate Dehydrogenase (LD) 200 IU/L 94 - 250
  PERFORMED AT WEST STAT LAB
Alkaline Phosphatase 109 IU/L 39 - 117
  PERFORMED AT WEST STAT LAB
Amylase 46 IU/L 0 - 100
  PERFORMED AT WEST STAT LAB
Bilirubin, Total 0.6 mg/dL 0 - 1.5
  PERFORMED AT WEST STAT LAB
OTHER ENZYMES & BILIRUBINS
Lipase 29 IU/L 0 - 60
  PERFORMED AT WEST STAT LAB
CHEMISTRY
Albumin 3.9 g/dL 3.4 - 4.8
  PERFORMED AT WEST STAT LAB
Calcium, Total 8.9 mg/dL 8.4 - 10.2
  PERFORMED AT WEST STAT LAB
Phosphate 2.7 mg/dL 2.7 - 4.5
  PERFORMED AT WEST STAT LAB
Magnesium 2.5 mg/dL 1.6 - 2.6
  PERFORMED AT WEST STAT LAB
PITUITARY
Thyroid Stimulating Hormone 0.41 uIU/mL 0.27 - 4.2

Hematology
GENERAL URINE INFORMATION Type Color Appear Sp [**Last Name (un) **]
[**2198-12-11**] 11:09PM      Yellow Clear 1.027
Source: CVS
DIPSTICK URINALYSIS Blood Nitrite Protein Glucose Ketone Bilirub
Urobiln pH Leuks
[**2198-12-11**] 11:09PM    NEG NEG NEG 1000 NEG NEG 4* 6.5 NEG
Source: CVS

[**2198-12-11**] 11:09PM
Source: CVS

06:37a
Other Blood Chemistry:
%HbA1c: 5.8
Comments: %HbA1c: [**Doctor First Name **] Recommendations:; <7% Goal Of Therapy; >8%
Warrants Therapeutic Action

Other Blood Chemistry:
Cryoglb: Negative

TSH:0.44
Other Blood Chemistry:
T4: 4.6
PEP: No Specific Abnormalities Seen;Interpreted By [**Name6 (MD) 1158**] [**Name8 (MD) **], Md
HCV-Ab: Negative

SED-Rate: 1

[**Hospital1 69**]
[**Location (un) 86**], [**Telephone/Fax (1) 15701**]

Pathology Examination

Name Birthdate    Age     Sex Pathology #     [**Hospital1 18**] [**Known lastname 75471**],[**Known firstname **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) 3947**]       [**2118-7-10**]    80 Male      [**-7/4824**]
[**Numeric Identifier 75472**]
Report to:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]
Gross Description by:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/dif



SPECIMEN SUBMITTED: Brain tumor.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2198-12-8**] [**2198-12-8**] [**2198-12-14**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/tcc

DIAGNOSIS:



Brain, stereotactic core biopsies, seven:

1.  "-3" (A):  Anaplastic Oligoastrocytoma, grade III (see
note).



2.  "-2":  Glial neoplasm.



3.  "-1" (B):  Anaplastic Oligoastrocytoma, grade III (see
note).



4.  "0":  Glial neoplasm.



5.  "+1" (C):  Anaplastic Oligoastrocytoma, grade III (see
note).



6.  "+2":  Glial neoplasm.



7.  "+3" (D):  Anaplastic Oligoastrocytoma, grade III (see
note).



Note:  The tumor shows areas with microgemistocytes and halos
suggesting an oligodendroglial differentiation.  Other areas
show clear fibrillary processes positive for GFAP
(immunohistochemistry) suggesting astroglial differentiation.
LCA immunohistochemistry identifies macrophages in this tumor.

Clinical:   "Brain tumor."
Gross:  The specimen is received in seven containers, labeled
with the patient's name "[**Known firstname **] [**Initial (NamePattern1) **]. [**Known lastname 14039**]" and the medical record
number.



Part 1 is received in formalin additionally labeled "-3" and
consists of a tan white fragment of tissue measuring 0.1 x 0.1 x
0.1 cm. The specimen is entirely submitted in A.



Part 2 is received fresh and additionally labeled "-2" and
consists of a tan white fragment of tissue measuring 0.1 x 0.1 x
0.1 cm. An intraoperative consultation was performed and the
entire specimen was smeared onto a slide. Intraoperative smear
diagnosis (SM -2) is "glial neoplasm" by Dr. [**First Name (STitle) 4223**].



Part 3 is received in formalin and additionally labeled "-1" and
consists of a tan white fragment of tissue measuring 0.1 x 0.1 x
0.1 cm.  The specimen is entirely submitted in B.



Part 4 is received fresh and additionally labeled "0" and
consists of a tan white fragment of tissue measuring 0.1 x 0.1 x
0.1 cm.  An intraoperative consultation was performed and the
entire specimen is smeared onto a slide.  Intraoperative smear
diagnosis (SM TP) is "glial neoplasm" by Dr. [**First Name (STitle) 4223**].



Part 5 is additionally labeled "+1" and consists of a fragment
of tan white tissue measuring 0.1 x 0.1 x 0.1 cm. The specimen
is entirely submitted in C.



Part 6 is received fresh and is additionally labeled "+2" and
consists of a tiny tan white fragment of tissue that measures
0.1 x 0.1 x 0.1 cm. An intraoperative consultation was performed
 and the entire specimen is smeared onto a slide. Smear
diagnosis (SM +2) is "glial neoplasm" by Dr. [**First Name (STitle) 4223**].



Part 7 is received in formalin and is additionally labeled "+3"
and consists of a tan white fragment of tissue measuring 0.1 x
0.1 x 0.1 cm. The specimen is entirely submitted in D.


Brief Hospital Course:
Patient is a 80 yo man with PMH of HTN, hyperlipid, h/o
afib, osteoporosis, DM2, low testosterone, prostate ca s/p
radiation who is transferred from [**Hospital3 **] with a necrotic brain
lesion in the left parietal/occipital area.  There is nothing on
physical exam to suggest mass effect. In [**Hospital3 **] his Coumadin
was held, and he was started on Keppra and Decadron which we
have continued. He has recent diagnosis and treatment of
prostate CA, however this does not metastasize to the brain
parenchyma. Primary neoplasm such as GBM, less likely CNS
lymphoma. He had a repeat MRI with gad.

On [**12-7**] he underwent a brain biopsy; pathology report:
Anaplastic Oligoastrocytoma, grade III

On [**12-13**] he underwent a craniotomy for removal of the left
parietal mass.  Post operatively he spent the night in the SICU
to monitor his BP he required a Nitro drip intermittently.
Neurologically he was intact.

He was transferred to the surgical floor on [**12-14**].  PT saw the
patient and recommended rehab; OT was also consulted and
recommended short term rehab.


Medications on Admission:
Vytorin [**10-20**] daily
Januvia 100 daily
Miacalcin nasal spral 200 IU alternating each nostril QOD
Androgel 5% 2 pumps daily, shoulders and chest
Protonix 40mg PO BID
Oscal with Vit D 500 [**Hospital1 **]
Diovan 160 daily
Rythmol SR 225 Po BID
Astelin [**Hospital1 **]
Keppra 500 [**Hospital1 **]
Decadron 4mg IV or PO Q6hrs
RISS

ALL: sulfas?  redness with HCTZ.


Discharge Medications:
1. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
2. Calcitonin (Salmon) 200 unit/Actuation Aerosol, Spray Sig:
200 units  Nasal DAILY (Daily).
3. Testosterone 1 %(50 mg/5 gram) Gel in Packet Sig: 1%  /2pumps
50mg/5gm Transdermal daily (): apply transdermal to chest and
shoulders.
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
6. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
11. Propafenone 150 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
12. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
13. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

14. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H () as needed.
15. Valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
17. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours).
18. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
19. Hydralazine 20 mg/mL Solution Sig: One (1)  Injection Q6H
(every 6 hours) as needed for SBP>140.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 11057**] Nursing & Rehabilitation Center - [**Location (un) 3320**]

Discharge Diagnosis:
Left Temporal Parietal Mass
Anaplastic Oligoastrocytoma, grade III


Discharge Condition:
Neurologically stable


Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR CRANIOTOMY/HEAD INJURY

??????	Have a 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,
excessive bending
??????	You may wash your hair only after sutures and/or staples have
been removed
??????	You may shower before this time with assistance and use of a
shower cap
??????	Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered

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, drainage
??????	Fever greater than or equal to 101?????? F

Followup Instructions:
PLEASE HAVE YOUR STAPLES/SUTURES REMOVED BETWEEN [**2198-12-23**] TO
[**2198-12-26**] IN REHAB FACILITY OR DR[**Doctor Last Name **] OFFICE (PLEASE CALL
([**Telephone/Fax (1) 11314**] FOR APPOINTMENT)

PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR.
[**Last Name (STitle) **] TO BE SEEN IN 4 WEEKS.
YOU WILL NEED A CAT SCAN OF THE BRAIN WITHOUT CONTRAST PRIOR TO
APPT.

Appointment with Dr [**Last Name (STitle) 4253**] in brain tumor clinic on [**12-21**] (Friday) at 1pm on the [**Hospital Ward Name 516**], [**Hospital Ward Name 23**] Building, [**Location (un) **].

If you need to cancel or reschedule the appt., please call
[**Telephone/Fax (1) 1844**]



Completed by:[**2198-12-18**]
{'Malignant neoplasm of parietal lobe,Hemiplegia, unspecified, affecting unspecified side,Hyposmolality and/or hyponatremia,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoporosis, unspecified,Tear film insufficiency, unspecified,Personal history of malignant neoplasm of prostate,Other postprocedural status,Personal history of tobacco use'}


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: [**3-4**] wk feeling unsteady

PRESENT ILLNESS: Patient is a 80 yo man with PMH of HTN, hyperlipid, h/o
afib, osteoporosis, DM2, low testosterone, prostate ca s/p
radiation who is transferred from [**Hospital3 **] with a necrotic brain
lesion in the left parietal/occipital area. Reports that he went
to his PCP recently with 3-4 weeks of spells of unsteadiness. He
describes it as feeling as if he is going to tip over. There is
no dizziness or vertigo with this.  His PCP ordered the CT and
he
was admitted for further work up including a non contrast MRI.
Notes mention both primary and secondary as possibilities, but
there is no official report.  CT torso mentioned as negative but
no official repport.

MEDICAL HISTORY: -HTN
-hyperlipid
-h/o afib
-osteoporosis
-DM2
-low testosterone
-prostate ca s/p radiation
-chronic dry eyes.

MEDICATION ON ADMISSION: Vytorin [**10-20**] daily
Januvia 100 daily
Miacalcin nasal spral 200 IU alternating each nostril QOD
Androgel 5% 2 pumps daily, shoulders and chest
Protonix 40mg PO BID
Oscal with Vit D 500 [**Hospital1 **]
Diovan 160 daily
Rythmol SR 225 Po BID
Astelin [**Hospital1 **]
Keppra 500 [**Hospital1 **]
Decadron 4mg IV or PO Q6hrs
RISS

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: T- 98.0   BP- 176/80  HR- 80  RR- 12  O2Sat  97 RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple, 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: Father died at 78 and mother in 90s both of MI.

SOCIAL HISTORY: Pt is a retired school superintendent. Pt quit smoking 40 [**Month/Year (2) 1686**]
ago, reports drinking 6 [**Last Name (un) 75470**]/week.  Pt lives alone since
wife died 2 [**Name2 (NI) 1686**] ago.  Daughter lives on [**Location (un) 945**] and son lives
in [**Name (NI) **]. 

### Response:
{'Malignant neoplasm of parietal lobe,Hemiplegia, unspecified, affecting unspecified side,Hyposmolality and/or hyponatremia,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoporosis, unspecified,Tear film insufficiency, unspecified,Personal history of malignant neoplasm of prostate,Other postprocedural status,Personal history of tobacco use'}
