CHIEF COMPLAINT: Headache

PRESENT ILLNESS: 58M with hx of HTN, HL, GERD presenting with 3-4 weeks of
[**Hospital 91670**] from OSH after CT head showed new R frontal mass.
He says he first began having headaches about 3-4 weeks ago.
They were initially occurring [**1-11**] x per week but within the last
week have been occurring daily. He does not usually get
headaches so this was unusual for him. He describes the
headaches as a
throbbing pain over his whole head. Recently they have been
present when he awakes in the morning and last all
day,fluctuating somewhat in severity. He takes advil
occasionally which helps somewhat. He also reports some nausea
and decreased appetite when the pain is severe; has not vomited.
His wife also
notes some cognitive changes over the last 6-9 months including
increased forgetfulness, "vagueness," just not quite acting like
himself. He saw his PCP today due to the increased frequency of
his headaches and was sent to [**Hospital 8641**] Hospital for a CT scan. The
scan showed a large R frontal mass and he was transferred to
[**Hospital1 18**] for further evaluation.

MEDICAL HISTORY: HTN
HL
GERD
PVD

MEDICATION ON ADMISSION: brimonidine-timolol [Combigan]0.2-0.5 % Drops
One (1) Ophthalmic three times a day.

ALLERGIES: IV Dye, Iodine Containing Contrast Media / myeclog cream

PHYSICAL EXAM: Upon admission
The pt was awake alert and oriented with a non focal
neurological exam.  His headaches were controlled with oral
medication.

FAMILY HISTORY: Mother with [**Name (NI) 11964**] / renal cell carcinoma
Father with stroke in 60's
Sister with brain tumor - unknown what type, family says it is
"deep" and inoperable so she is being monitored, asymptomatic
and
has been stable.

SOCIAL HISTORY: Lives at home with wife and step daughter. [**Name (NI) 1403**] as a machinist
for GE. Never smoked, drinks occasional alcohol. Denies
illicits.
Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Other dural tear,Malignant neoplasm of kidney, except pelvis,Unspecified disorder of kidney and ureter,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Unspecified glaucoma,Family history of malignant neoplasm of kidney,Obesity, unspecified,Body Mass Index 32.0-32.9, adult
Sec mal neo brain/spine,Cerebral edema,Ac DVT/emb distl low ext,Dural tear NEC,Malig neopl kidney,Renal & ureteral dis NOS,Hypertension NOS,Periph vascular dis NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Glaucoma NOS,Family hx-kidney malig,Obesity NOS,BMI 32.0-32.9,adult
Admission Date:  [**2184-10-8**]              Discharge Date:   [**2184-10-13**]

Date of Birth:  [**2126-8-27**]             Sex:   M

Service: NEUROSURGERY

Allergies:
IV Dye, Iodine Containing Contrast Media / myeclog cream

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Headache

Major Surgical or Invasive Procedure:
[**2184-10-8**]: Bifrontal craniotomy for tumor resection


History of Present Illness:
58M with hx of HTN, HL, GERD presenting with 3-4 weeks of
[**Hospital 91670**] from OSH after CT head showed new R frontal mass.
He says he first began having headaches about 3-4 weeks ago.
They were initially occurring [**1-11**] x per week but within the last
week have been occurring daily. He does not usually get
headaches so this was unusual for him. He describes the
headaches as a
throbbing pain over his whole head. Recently they have been
present when he awakes in the morning and last all
day,fluctuating somewhat in severity. He takes advil
occasionally which helps somewhat. He also reports some nausea
and decreased appetite when the pain is severe; has not vomited.
His wife also
notes some cognitive changes over the last 6-9 months including
increased forgetfulness, "vagueness," just not quite acting like
himself. He saw his PCP today due to the increased frequency of
his headaches and was sent to [**Hospital 8641**] Hospital for a CT scan. The
scan showed a large R frontal mass and he was transferred to
[**Hospital1 18**] for further evaluation.

Past Medical History:
HTN
HL
GERD
PVD

PSH:
L knee surgery
Umbilical hernia repair


Social History:
Lives at home with wife and step daughter. [**Name (NI) 1403**] as a machinist
for GE. Never smoked, drinks occasional alcohol. Denies
illicits.


Family History:
Mother with [**Name (NI) 11964**] / renal cell carcinoma
Father with stroke in 60's
Sister with brain tumor - unknown what type, family says it is
"deep" and inoperable so she is being monitored, asymptomatic
and
has been stable.


Physical Exam:
Upon admission
The pt was awake alert and oriented with a non focal
neurological exam.  His headaches were controlled with oral
medication.

Upon discharge ************

Pertinent Results:
[**2184-10-8**] PATHOLOGY

[**2184-10-8**] MRI BRAIN
Final Report
CLINICAL HISTORY: 58-year-old man with headache. Diagnosed to
have right
frontal lesion on MRI. Pre-surgical mapping.

COMPARISON: MRI without and with contrast dated [**2184-10-1**].

TECHNIQUE: Axial T1 and axial MP-RAGE images were obtained after

administration of contrast with sagittal and coronal
reconstructions.

FINDINGS: Again is noted an enhancing mass in the right
basifrontal region
measuring 2.6 x 2.4 x 2.2 cm in craniocaudad, AP and transverse
dimensions.  It is associated significant perilesional edema. It
causes mass effect on the surrounding brain parenchyma and the
frontal [**Doctor Last Name 534**] of right lateral ventricle. A prominent vessel is
noted arising from right supraclinoid internal carotid artery
and reaching upto the lesion suggestive of hypervascularity of
the lesion. The lesion is more likely intra-axial rather than
extra-axial.

There is no evidence of new enhancing lesion. The ventricles are
stable in
size. Brainstem and cerebellum appear normal. The visualized
paranasal
sinuses and mastoid air cells are clear. Orbits are
unremarkable.

IMPRESSION:

Enhancing right basifrontal mass with surrounding perilesional
edema and mass effect which is unchanged since the prior study.
The lesion is more likely intra-axial rather than extra-axial.
This likely represents metastasis.

[**2184-10-8**] CT BRAIN
Final Report
INDICATION: Right frontal tumor, status post craniotomy for
resection.
Please evaluate for postoperative changes.

TECHNIQUE: Sequential axial images were acquired through the
head without
administration of intravenous contrast material.

COMPARISON: MR head from [**2184-10-8**], at 09:45 a.m.

FINDINGS: The patient is status post frontal craniotomy with
resection of a
right frontal lobe lesion. There is a small quantity of
hemorrhage within the resection bed. Mild pneumocephalus is seen
overlying both frontal lobes.  There is vasogenic edema within
the right frontal lobe with associated 9 mm leftward shift of
the normally midline structures (2:14), not significantly
changed compared to the prior MR. There is no large volume
intracranial hemorrhage. There is no evidence of acute large
vascular territorial infarction. The ventricles are normal in
size. Aerosolized secretions and fluid is seen within the
frontal sinuses and middle and anterior ethmoidal air cells. The
remainder of the visualized portions of the paranasal sinuses
and mastoid air cells are well aerated.

IMPRESSION:

1. Expected postoperative changes in the right frontal lobe,
status post
resection of a right frontal lobe mass.

2. Persistent vasogenic edema within the right frontal lobe
along with
unchanged leftward shift of normally midline structures.

3. No large volume intracranial hemorrhage.

4. Minimal new pneumocephalus overlying both frontal lobes.

[**2184-10-9**] MRI BRAIN
Final Report
EXAM: MRI brain.

CLINICAL INFORMATION: Status post resection of brain tumor.

TECHNIQUE: T1 sagittal and axial and FLAIR T2 susceptibility and
diffusion
axial images were obtained before gadolinium. T1 axial and
MP-RAGE sagittal images acquired following gadolinium.
Comparison was made with the MRI of [**2184-10-8**].

FINDINGS: Since the previous study, the patient has undergone
resection of
right inferior frontal lobe mass. Blood products and air are
seen in the
region. No definite residual enhancement identified. Linear,
somewhat
tortuous area of enhancement indicating a vascular structure
posterior to the surgical cavity is again identified, unchanged
from prior study. There is dural enhancement in the region which
could be postoperative in nature. The edema in the right frontal
lobe is unchanged. No midline shift or
hydrocephalus seen. There is no new area of restricted diffusion
to suggest acute infarct.

IMPRESSION: Status post resection of right inferior frontal lobe
mass with
blood products in the region. The enhancement at the margin of
the surgical cavity is mostly meningeal and could be
postoperative in nature. No definite residual parenchymal
enhancement is seen. No evidence of acute infarct, mass effect,
or hydrocephalus. The edema is unchanged

LENIS [**2184-10-11**] -
1. Superficial thrombosis of the lesser saphenous vein of the
right calf,
with additional deep venous thrombosis of what is likely the
gastrocnemius
vein on the right.
2. No evidence of DVT in left lower extremity.


Brief Hospital Course:
Pt electively admitted and underwent a bifrontal craniotomy with
cranialization of the frontal sinus.  Plastic surgery was
involved with the procedure.  The pt awoke from anesthesia
without complication and was extubated immediately.  He was
started on a 7 day course of Ancef for sinus coverage.  He
remained in the ICU overnight and then was transferred to step
down.  His post operative imaging was stable.

He was seen and evaluated by PT OT.  There were no events.
Medicine and radiation oncology teams were [**Month/Day/Year 653**] regarding
completed treatment.  On [**2184-10-11**], pt had a LENIs which
demonstrated a right calf DVT.  Given that he had a craniotomy,
it was demed that patient require a IVC filter.  IR was
consulted for IR IVC filter placement. Because of a clot in the
IVC, a filter was not placed. He is to continue his SQH while in
hospital. On [**10-13**], patient is ambulatory and voiding
appropriately. Pathology results are still pending and PT has
cleared patient safe to go home with PT. His IV antibiotics was
changed to PO cephalexin and he will have a slow taper of his
decadron. He was discharge home on [**10-13**]. He can also restart his
aspirin 81mg today.

Medications on Admission:
brimonidine-timolol [Combigan]0.2-0.5 % Drops
One (1) Ophthalmic three times a day.

brinzolamide 1 % Drops, Suspension
One (1) Ophthalmic three times a day.

dexamethasone 2 mg Tablet
Two (2) Tablet by mouth every six (6) hours. 240  Tablet(s) 2

fiorocet 1-2 tabs every six (6) hours as needed for pain. 30   0

hydrochlorothiazide12.5 mg Capsule
Two (2) Capsule by mouth DAILY (Daily).

latanoprost0.005 % Drops one (1) Drop Ophthalmic HS (at
bedtime).

levetiracetam750 mg Tablet
One (1) Tablet by mouth twice a day. 60  Tablet(s) 2

lisinopril20 mg Tablet
Two (2) Tablet by mouth DAILY (Daily).

omeprazole20 mg Capsule, Delayed Release(E.C.)
Two (2) Capsule, Delayed Release(E.C.) by mouth DAILY (Daily).


pravastatin20 mg Tablet
Two (2) Tablet by mouth DAILY (Daily).


Discharge Medications:
1. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. pravastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Combigan 0.2-0.5 % Drops Sig: One (1)  Ophthalmic tid ().
5. brinzolamide 1 % Drops, Suspension Sig: One (1)  Ophthalmic
tid ().
6. latanoprost 0.005 % Drops Sig: One (1)  Ophthalmic qhs ().
7. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*2*
9. dexamethasone 2 mg Tablet Sig: refer to other instructions
Tablet PO refer to other instructions: Please take 3mg (1 [**1-11**]
tab) TID for 2 days, then take 2mg (1 tab) TID for 5 days, then
2mg (1 tab) [**Hospital1 **] until seen in follow up.
Disp:*100 Tablet(s)* Refills:*2*
10. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
11. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
12. cephalexin 500 mg Tablet Sig: One (1) Tablet PO every six
(6) hours for 2 days.
Disp:*8 Tablet(s)* Refills:*0*
13. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 34004**]

Discharge Diagnosis:
Right frontal brain tumor
Deep vein thrombosis right gastroc vein
Elevated BUN
High blood pressure


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


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 for removal of a right frontal brain tumor which
was discovered at your last hospital admission. The operation
was successful and was a combined procedure with both plastic
surgery and neurosurgery involved and the biopsy result from
this is awaited. You were also found to have a deep vein
thrombosis in your right calf revealed on ultrasound tests of
your legs. We discussed treatment options with oncology and
given taht interventional radiology felt that placing a filter
was unsafe due to vein involvement of your renal cancer. You
were therefore started on aspirin. You were also started on
anti-seizure medication given the risk of seizures following
your brain tumor removal.

You did well post-operatively and were deemed safe for discharge
on [**2184-10-13**]. You have a brain [**Hospital 91671**] clinic appointment on
[**2184-10-25**] with MRI. You also have neuro-oncology follow-up as
below.

General Instructions

??????	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 with a mild shampoo, or just wanter run
over your incision.
??????	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, Advil, and Ibuprofen
etc for one week post operativly.
??????	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.
??????	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, unless you have been instructed not to.

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


Followup Instructions:
Follow-Up Appointment Instructions

??????Please return to the office in [**7-18**] days(from your date of
surgery) for removal of your staples/sutures and/or a wound
check.  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.
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**First Name (STitle) **], to be seen in 6 weeks.
??????You will need an MRI of the brain with and without gadolinium
contrast.

YOU HAVE AN APPOINTMENT IN THE BRAIN [**Hospital **] CLINIC ON
[**10-25**] with an MRI at 7:55 am [**Hospital Ward Name 23**] 4 and Brain [**Hospital 341**]
Clinic at 9:30 / IF YOU ARE UNABLE TO MAKE THIS APPOINTMENT PLS
CALL [**Telephone/Fax (1) **]

Department: NEUROLOGY
When: MONDAY [**2184-10-25**] at 11:30 AM
With: [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) 4861**], MD [**Telephone/Fax (1) 1844**]
Building: [**Hospital6 29**] [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

If Pathology does show that kidney is your primary lesion,
please contact Dr. [**Last Name (STitle) 9449**], Dr. [**Last Name (STitle) **], and Dr. [**Last Name (STitle) **] at
[**Telephone/Fax (1) 82797**] to schedule an appointment to be seen.



Completed by:[**2184-10-13**]

Name:  [**Known lastname 855**],[**Known firstname 63**]                    Unit No:   [**Numeric Identifier 14435**]

Admission Date:  [**2184-10-8**]              Discharge Date:   [**2184-10-13**]

Date of Birth:  [**2126-8-27**]             Sex:   M

Service: NEUROSURGERY

Allergies:
IV Dye, Iodine Containing Contrast Media / myeclog cream

Attending:[**First Name3 (LF) 40**]
Addendum:
Physical Exam on discharge:
A&Ox3
PERRL
R periorbital ecchymosis, subconjunctival hemorrhage
Full strength
Incision c/d/i


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 7011**]

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 43**] MD [**MD Number(2) 44**]

Completed by:[**2184-10-13**]
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Other dural tear,Malignant neoplasm of kidney, except pelvis,Unspecified disorder of kidney and ureter,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Unspecified glaucoma,Family history of malignant neoplasm of kidney,Obesity, unspecified,Body Mass Index 32.0-32.9, adult'}


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

PRESENT ILLNESS: 58M with hx of HTN, HL, GERD presenting with 3-4 weeks of
[**Hospital 91670**] from OSH after CT head showed new R frontal mass.
He says he first began having headaches about 3-4 weeks ago.
They were initially occurring [**1-11**] x per week but within the last
week have been occurring daily. He does not usually get
headaches so this was unusual for him. He describes the
headaches as a
throbbing pain over his whole head. Recently they have been
present when he awakes in the morning and last all
day,fluctuating somewhat in severity. He takes advil
occasionally which helps somewhat. He also reports some nausea
and decreased appetite when the pain is severe; has not vomited.
His wife also
notes some cognitive changes over the last 6-9 months including
increased forgetfulness, "vagueness," just not quite acting like
himself. He saw his PCP today due to the increased frequency of
his headaches and was sent to [**Hospital 8641**] Hospital for a CT scan. The
scan showed a large R frontal mass and he was transferred to
[**Hospital1 18**] for further evaluation.

MEDICAL HISTORY: HTN
HL
GERD
PVD

MEDICATION ON ADMISSION: brimonidine-timolol [Combigan]0.2-0.5 % Drops
One (1) Ophthalmic three times a day.

ALLERGIES: IV Dye, Iodine Containing Contrast Media / myeclog cream

PHYSICAL EXAM: Upon admission
The pt was awake alert and oriented with a non focal
neurological exam.  His headaches were controlled with oral
medication.

FAMILY HISTORY: Mother with [**Name (NI) 11964**] / renal cell carcinoma
Father with stroke in 60's
Sister with brain tumor - unknown what type, family says it is
"deep" and inoperable so she is being monitored, asymptomatic
and
has been stable.

SOCIAL HISTORY: Lives at home with wife and step daughter. [**Name (NI) 1403**] as a machinist
for GE. Never smoked, drinks occasional alcohol. Denies
illicits. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Other dural tear,Malignant neoplasm of kidney, except pelvis,Unspecified disorder of kidney and ureter,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Unspecified glaucoma,Family history of malignant neoplasm of kidney,Obesity, unspecified,Body Mass Index 32.0-32.9, adult'}
