CHIEF COMPLAINT: Dizziness, blurred vision, sellar mass

PRESENT ILLNESS: This a 67 years old right handed man with a past medical history
of CAD s/p CABG, A.fib, and subdural hematoma s/p a left
frontoparietal craniotomy who presented to the [**Hospital1 18**] Brain Tumor
Center for the evaluation of dizziness, blurred vision and a
mass
in the tuberculum sella. Patient reports a history of dizziness
and blurred vision which started about 3 months ago. Patient
described this dizziness as feeling unsteady when trying to
ambulate. He denies any vertigo, hearing loss or palpitation. He
associates this symptom as starting after he tried to lose
weight
by dieting. Symptoms happen in the midmornings and these
symptoms
tend to fluctuate.
He also reports blurred vision mainly in his right eye. He had
right eye surgery for cataract removal 3 years ago and now has
an
implant. He denies any blindness or diplopia. He also reports
headaches which are diffused. These headaches are transient and
last last about 5 minutes. The do not happen everyday. He saw
his
PCP who tried him on motion sickness medications with no
benefits. He then saw Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 9192**], a neurologist [**2152-7-19**]
who ordered an MRI/brain [**2152-7-24**] which showed a mass in the
tuberculum of the sella.

MEDICAL HISTORY: 1.Atrial fibrillation
2.Heart Disease s/p mechanical valve
3.COPD
4.GERD
5.CAD s/p CABG
6.Subdural Hematoma s/p left frontoparietal craniotomy
7.Right eye cataract s/p right eye implant.
8.Anxiety

MEDICATION ON ADMISSION: advair, albuterol, dizaepam, digoxin, MVI, omeprazole, crestor,
warfarin, zolpidem, spiriva

ALLERGIES: House Dust

PHYSICAL EXAM: Temperature: 96.6 Blood pressure: 131/78 Pulse: 72 Respiration:
18 Oxygen saturation: 95%/RA.
Neurological Examination:
Patient is alert, awake and oriented times 3. His Karnofsky
Performance Score is 100.  He is awake, alert, and oriented
times
3.  There is no right/left confusion or finger agnosia.  His
calculation ability is intact.  His language is fluent with good
comprehension, naming, and repetition. Recent recall is intact.
Cranial Nerve Examination:  His pupils are equal and reactive to
light, 4 mm to 2 mm bilaterally.  Extraocular movements are
full.
Funduscopic examination reveals pale disk on the right eye and
sharp disk margin on the left. His face is symmetric. Facial
sensation is intact bilaterally. His hearing is intact
bilaterally.  His tongue is midline.  Palate goes up in the
midline. Sternocleidomastoids and upper trapezius are strong.
Motor Examination: He does not have a drift.  His muscle
strengths are [**6-8**] at all muscle groups.  He has cogwheel
ridigity
on activation. His reflexes are +3 bilaterally.  His toes are
downgoing. Sensory examination is intact to touch and
proprioception. Coordination examination does not reveal
dysmetria.  His gait examination was normal.
On general examination, the oropharynx is clear, the
lungs are clear, the heart is regular. The legs are without
edema
or tenderness. Healed wound of the left leg with signs of tibia
fracture.

FAMILY HISTORY: Mother had CAD and colon CA in her mid 70's. Father had COPD.

SOCIAL HISTORY: He is divorced. He is also retired as a high school teacher and
electrician. He smoked for 50 years and quite in [**2148**]. He denies
any alcohol or illicit drugs use.
Malignant neoplasm of cerebral meninges,Subdural hemorrhage,Hemorrhage complicating a procedure,Coronary atherosclerosis of unspecified type of vessel, native or graft,Atrial fibrillation,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anxiety state, unspecified,Esophageal reflux,Chronic airway obstruction, not elsewhere classified,Aortocoronary bypass status,Heart valve replaced by other means,Physical restraints status
Mal neo cerebral mening,Subdural hemorrhage,Hemorrhage complic proc,Cor ath unsp vsl ntv/gft,Atrial fibrillation,Abn react-surg proc NEC,Anxiety state NOS,Esophageal reflux,Chr airway obstruct NEC,Aortocoronary bypass,Heart valve replac NEC,Physical restrain status
Admission Date:  [**2152-11-24**]              Discharge Date:   [**2152-11-28**]

Date of Birth:  [**2085-5-14**]             Sex:   M

Service: NEUROSURGERY

Allergies:
House Dust

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Dizziness, blurred vision, sellar mass

Major Surgical or Invasive Procedure:
[**11-24**] Right Sided Craniotomy for Mass resection


History of Present Illness:
This a 67 years old right handed man with a past medical history
of CAD s/p CABG, A.fib, and subdural hematoma s/p a left
frontoparietal craniotomy who presented to the [**Hospital1 18**] Brain Tumor
Center for the evaluation of dizziness, blurred vision and a
mass
in the tuberculum sella. Patient reports a history of dizziness
and blurred vision which started about 3 months ago. Patient
described this dizziness as feeling unsteady when trying to
ambulate. He denies any vertigo, hearing loss or palpitation. He
associates this symptom as starting after he tried to lose
weight
by dieting. Symptoms happen in the midmornings and these
symptoms
tend to fluctuate.
He also reports blurred vision mainly in his right eye. He had
right eye surgery for cataract removal 3 years ago and now has
an
implant. He denies any blindness or diplopia. He also reports
headaches which are diffused. These headaches are transient and
last last about 5 minutes. The do not happen everyday. He saw
his
PCP who tried him on motion sickness medications with no
benefits. He then saw Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 9192**], a neurologist [**2152-7-19**]
who ordered an MRI/brain [**2152-7-24**] which showed a mass in the
tuberculum of the sella.

Past Medical History:
1.Atrial fibrillation
2.Heart Disease s/p mechanical valve
3.COPD
4.GERD
5.CAD s/p CABG
6.Subdural Hematoma s/p left frontoparietal craniotomy
7.Right eye cataract s/p right eye implant.
8.Anxiety


Social History:
He is divorced. He is also retired as a high school teacher and
electrician. He smoked for 50 years and quite in [**2148**]. He denies
any alcohol or illicit drugs use.

Family History:
Mother had CAD and colon CA in her mid 70's. Father had COPD.

Physical Exam:
Temperature: 96.6 Blood pressure: 131/78 Pulse: 72 Respiration:
18 Oxygen saturation: 95%/RA.
Neurological Examination:
Patient is alert, awake and oriented times 3. His Karnofsky
Performance Score is 100.  He is awake, alert, and oriented
times
3.  There is no right/left confusion or finger agnosia.  His
calculation ability is intact.  His language is fluent with good
comprehension, naming, and repetition. Recent recall is intact.
Cranial Nerve Examination:  His pupils are equal and reactive to
light, 4 mm to 2 mm bilaterally.  Extraocular movements are
full.
Funduscopic examination reveals pale disk on the right eye and
sharp disk margin on the left. His face is symmetric. Facial
sensation is intact bilaterally. His hearing is intact
bilaterally.  His tongue is midline.  Palate goes up in the
midline. Sternocleidomastoids and upper trapezius are strong.
Motor Examination: He does not have a drift.  His muscle
strengths are [**6-8**] at all muscle groups.  He has cogwheel
ridigity
on activation. His reflexes are +3 bilaterally.  His toes are
downgoing. Sensory examination is intact to touch and
proprioception. Coordination examination does not reveal
dysmetria.  His gait examination was normal.
On general examination, the oropharynx is clear, the
lungs are clear, the heart is regular. The legs are without
edema
or tenderness. Healed wound of the left leg with signs of tibia
fracture.

On Discharge:
A&Ox3
full motor


Pertinent Results:
[**11-24**] MRI Brain with and without contrast: IMPRESSION:
Presurgical planning evaluation for a homogeneously enhancing
mass arising from the planum sphenoidale as detailed above.

[**11-24**] CT head noncontrast: Postoperative changes in the form of
right frontal and temporal craniotomy and pneumocephalus in
bilateral frontal region and right temporal region. Mild
intraventricular hemorrhage in occipital horns of bilateral
lateral ventricles which is likely post operative.

[**11-25**] MRI BRain with and without contrast:
1. Post-surgical changes with right-sided craniotomy and an
extra-axial fluid collection, measuring approximately 1.8 cm
with displacement of the right frontal lobe and shift of the
midline structures towards the left side by 5 mm. Hemorrhagic
components are noted within the fluid collection related to the
recent procedure.
2. Interval resection of the previously noted tumor in the
sellar/suprasellar
regions with minimal enhancement along the dura likely related
to
post-surgical changes. Significant improvement in the previously
noted mass effect on the optic chiasm.




Brief Hospital Course:
Patient presented electively on [**11-24**] for a right sided
craniotomy for tumor resection. he toelrated the procedure well,
was extubated in the operating room, and was transferred to the
intensive care unit post-operatively for frequent neuro checks
and SBP control less than 140. POstop head CT demonstratd no
hemorrhage.  Postoperatively he was started on dexamethasone 4mg
IV Q6 hours.

On POD 1 [**11-25**] he was transfered to the regular floor.  POstop
MRI was performed that demonstrated good resection of the mass.
He advanced his diet and began to mobilize.  In the evening on
POD1 and on POD2 he was slightly confused and became agitated
requiring temporary restraints and Haldol 1mg IV x1 dose on
[**11-26**].

By [**11-27**] his exam was greatly improved and he no longer required
restraints.  The Dexamethasone was tapered rapidly as it was
felt to cause psychosis.

On [**11-28**], patient remained stable, he was discharged to rehab.

Medications on Admission:
advair, albuterol, dizaepam, digoxin, MVI, omeprazole, crestor,
warfarin, zolpidem, spiriva

Discharge Medications:
1. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain/headache.
5. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for headache.
6. insulin regular human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
7. glucagon (human recombinant) 1 mg Recon Soln Sig: One (1)
Recon Soln Injection Q15MIN () as needed for hypoglycemia
protocol.
8. zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime)
as needed for sleep.
9. diazepam 5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for anxiety.
10. multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

12. fluticasone-salmeterol 100-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
13. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q4H (every 4 hours) as needed for
wheeze.
14. rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
16. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
17. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
18. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
19. phenytoin 50 mg Tablet, Chewable Sig: Two (2) Tablet,
Chewable PO TID (3 times a day) for 3 days.
20. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 2 days.
21. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
22. erythromycin 5 mg/gram (0.5 %) Ointment Sig: One (1)
Ophthalmic QID (4 times a day) for 7 days.
23. dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q12 hrs ()
for 4 doses.
24. dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q 24 hrs ()
for 2 doses.
25. dexamethasone 4 mg Tablet Sig: One (1) Tablet PO Q12 HRS ()
for 4 doses.
26. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation.
27. Ondansetron 4 mg IV Q8H:PRN nausea


Discharge Disposition:
Extended Care

Facility:
[**Hospital 8971**] Rehabilitation Center (at [**Hospital6 8972**])
- [**Location (un) 8973**]

Discharge Diagnosis:
right subfrontal brain mass
right visual [**Last Name (un) 8491**] cut
CAD
CABG
Mechanical heart valve


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
****You may restart coumadin on [**2152-11-29**]***

You were admitted to the hospital for removal of a brain mass.
You underwent this procedure without incident.  Your vision
remains altered in your right eye and we will be getting formal
testing for you in 8 weeks time.  You were started on Dilantin
for seizure prophylaxis, this [**Last Name (un) **] transitioned over to Keppra
which is easier for you to manage as an out patient as you do
not need to follow laboratory levels.  Your steroids were weaned
slowly.
??????	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 and/or staples have
been removed. If your wound closure uses dissolvable sutures,
you must keep that area dry for 10 days.
??????	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.
??????	If you have been prescribed Dilantin (Phenytoin) for
anti-seizure medicine, take it as prescribed and follow up with
laboratory blood drawing in one week.  This can be drawn at your
PCP??????s office, but please have the results faxed to [**Telephone/Fax (1) 87**].
If you have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	If 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:
??????Please return to the office in [**8-13**] days (from your date of
surgery) for removal of your staples/sutures and/or 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 will need an appointment to be seen at the brain tumor
clinic. You will be contact[**Name (NI) **] with time and date of your
scheduled appointment. The Brain [**Hospital 341**] Clinic is located on the
[**Hospital Ward Name 516**] of [**Hospital1 18**], in the [**Hospital Ward Name 23**] Building, [**Location (un) **]. Their
phone number is [**Telephone/Fax (1) 1844**]. Please call if you need to change
your appointment, or require additional directions.



Completed by:[**2152-11-28**]
{'Malignant neoplasm of cerebral meninges,Subdural hemorrhage,Hemorrhage complicating a procedure,Coronary atherosclerosis of unspecified type of vessel, native or graft,Atrial fibrillation,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anxiety state, unspecified,Esophageal reflux,Chronic airway obstruction, not elsewhere classified,Aortocoronary bypass status,Heart valve replaced by other means,Physical restraints 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: Dizziness, blurred vision, sellar mass

PRESENT ILLNESS: This a 67 years old right handed man with a past medical history
of CAD s/p CABG, A.fib, and subdural hematoma s/p a left
frontoparietal craniotomy who presented to the [**Hospital1 18**] Brain Tumor
Center for the evaluation of dizziness, blurred vision and a
mass
in the tuberculum sella. Patient reports a history of dizziness
and blurred vision which started about 3 months ago. Patient
described this dizziness as feeling unsteady when trying to
ambulate. He denies any vertigo, hearing loss or palpitation. He
associates this symptom as starting after he tried to lose
weight
by dieting. Symptoms happen in the midmornings and these
symptoms
tend to fluctuate.
He also reports blurred vision mainly in his right eye. He had
right eye surgery for cataract removal 3 years ago and now has
an
implant. He denies any blindness or diplopia. He also reports
headaches which are diffused. These headaches are transient and
last last about 5 minutes. The do not happen everyday. He saw
his
PCP who tried him on motion sickness medications with no
benefits. He then saw Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 9192**], a neurologist [**2152-7-19**]
who ordered an MRI/brain [**2152-7-24**] which showed a mass in the
tuberculum of the sella.

MEDICAL HISTORY: 1.Atrial fibrillation
2.Heart Disease s/p mechanical valve
3.COPD
4.GERD
5.CAD s/p CABG
6.Subdural Hematoma s/p left frontoparietal craniotomy
7.Right eye cataract s/p right eye implant.
8.Anxiety

MEDICATION ON ADMISSION: advair, albuterol, dizaepam, digoxin, MVI, omeprazole, crestor,
warfarin, zolpidem, spiriva

ALLERGIES: House Dust

PHYSICAL EXAM: Temperature: 96.6 Blood pressure: 131/78 Pulse: 72 Respiration:
18 Oxygen saturation: 95%/RA.
Neurological Examination:
Patient is alert, awake and oriented times 3. His Karnofsky
Performance Score is 100.  He is awake, alert, and oriented
times
3.  There is no right/left confusion or finger agnosia.  His
calculation ability is intact.  His language is fluent with good
comprehension, naming, and repetition. Recent recall is intact.
Cranial Nerve Examination:  His pupils are equal and reactive to
light, 4 mm to 2 mm bilaterally.  Extraocular movements are
full.
Funduscopic examination reveals pale disk on the right eye and
sharp disk margin on the left. His face is symmetric. Facial
sensation is intact bilaterally. His hearing is intact
bilaterally.  His tongue is midline.  Palate goes up in the
midline. Sternocleidomastoids and upper trapezius are strong.
Motor Examination: He does not have a drift.  His muscle
strengths are [**6-8**] at all muscle groups.  He has cogwheel
ridigity
on activation. His reflexes are +3 bilaterally.  His toes are
downgoing. Sensory examination is intact to touch and
proprioception. Coordination examination does not reveal
dysmetria.  His gait examination was normal.
On general examination, the oropharynx is clear, the
lungs are clear, the heart is regular. The legs are without
edema
or tenderness. Healed wound of the left leg with signs of tibia
fracture.

FAMILY HISTORY: Mother had CAD and colon CA in her mid 70's. Father had COPD.

SOCIAL HISTORY: He is divorced. He is also retired as a high school teacher and
electrician. He smoked for 50 years and quite in [**2148**]. He denies
any alcohol or illicit drugs use. 

### Response:
{'Malignant neoplasm of cerebral meninges,Subdural hemorrhage,Hemorrhage complicating a procedure,Coronary atherosclerosis of unspecified type of vessel, native or graft,Atrial fibrillation,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anxiety state, unspecified,Esophageal reflux,Chronic airway obstruction, not elsewhere classified,Aortocoronary bypass status,Heart valve replaced by other means,Physical restraints status'}
