CHIEF COMPLAINT: Parkinson's Disease

PRESENT ILLNESS: Mr. [**Known lastname 66595**] is a young 36 year old male with Parkinson's disease
diagnosed in [**2165**]. Onset of symptoms was on the left side. His
presenting symptom was difficulty with left arm swing and
shoulder pain. His symptoms have progressed to involve both
sides, although still they are slightly asymmetric
with left-sided involved more than the right. He has major
problems with
rigidity and muscle cramping, bradykinesias, gait disorder,
freezing. He has no problems with tremor. He has minor problems
with dystonia as well as poor balance, dysarthria, hypophonia,
stooped posture and swallowing trouble. He
needs assistance to ambulate when he is off. Usually he needs to
hold on to somebody to support himself. Overall, 50% of the day
he is not able to function.

MEDICAL HISTORY: Parkinson's disease

MEDICATION ON ADMISSION: amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
pramipexole 0.5 mg Tablet Sig: One (1) Tablet PO Q3hrs ().
Stalevo 100 25-100-200 mg Tablet Sig: One (1) Tablet PO Q3hr ().

ALLERGIES: Penicillins / Erythromycin Base / Shellfish

PHYSICAL EXAM: On Discharge:HE has no cranial nerve deficit or motor or sensory
deficit. He has a surgical bandage which is clean and dry.

FAMILY HISTORY: His family history is noteworthy for the fact that his mother
had
heart disease, ovarian cancer, and adult onset diabetes, and
passed away at age 62.  His father is 71 years old and has a
history of prostate cancer, hypertension, and polymyalgia
rheumatica. His brother (age 47) has no known medical history.
Both of his sisters (age 49 & 33) have Crohn's disease. There is
no known family history of Parkinson's disease or other
neurologic disorders.

SOCIAL HISTORY: Mr. [**Known lastname 66595**] was born and raised in [**Location (un) 66596**], [**State 350**].
His wife reported that his mother had gestational diabetes, and
that Mr. [**Known lastname 66595**] was born 10 ?????? weeks premature with no
complications at birth, and that he met developmental milestones
at a normal rate. He stated that he attended public schools and
he did well.  He attended [**First Name4 (NamePattern1) 6930**] [**Last Name (NamePattern1) **] College where he
studied environmental science and graduated in [**2157**].  He worked
in a biotech company producing monoclonal antibodies, but has
not worked for several years.  He has been married twice.  His
first marriage lasted 14 years and he has two children (daughter
age 11, and son age 6) from that marriage.  His former wife
apparently left him when he was diagnosed with Parkinson's
disease.  She lives in [**Hospital1 614**] with the children, but he sees
them once or twice a month.  He has been married for a second
time for the last two years.  He appears to have a strong and
supportive relationship with his second wife.
Paralysis agitans,Unspecified essential hypertension
Paralysis agitans,Hypertension NOS
Admission Date:  [**2172-2-11**]              Discharge Date:   [**2172-2-12**]

Date of Birth:  [**2135-1-12**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Penicillins / Erythromycin Base / Shellfish

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
Parkinson's Disease

Major Surgical or Invasive Procedure:
Stage 1 Bilateral DBS electrode placement


History of Present Illness:
Mr. [**Known lastname 66595**] is a young 36 year old male with Parkinson's disease
diagnosed in [**2165**]. Onset of symptoms was on the left side. His
presenting symptom was difficulty with left arm swing and
shoulder pain. His symptoms have progressed to involve both
sides, although still they are slightly asymmetric
with left-sided involved more than the right. He has major
problems with
rigidity and muscle cramping, bradykinesias, gait disorder,
freezing. He has no problems with tremor. He has minor problems
with dystonia as well as poor balance, dysarthria, hypophonia,
stooped posture and swallowing trouble. He
needs assistance to ambulate when he is off. Usually he needs to
hold on to somebody to support himself. Overall, 50% of the day
he is not able to function.


Past Medical History:
Parkinson's disease

Social History:
Mr. [**Known lastname 66595**] was born and raised in [**Location (un) 66596**], [**State 350**].
His wife reported that his mother had gestational diabetes, and
that Mr. [**Known lastname 66595**] was born 10 ?????? weeks premature with no
complications at birth, and that he met developmental milestones
at a normal rate. He stated that he attended public schools and
he did well.  He attended [**First Name4 (NamePattern1) 6930**] [**Last Name (NamePattern1) **] College where he
studied environmental science and graduated in [**2157**].  He worked
in a biotech company producing monoclonal antibodies, but has
not worked for several years.  He has been married twice.  His
first marriage lasted 14 years and he has two children (daughter
age 11, and son age 6) from that marriage.  His former wife
apparently left him when he was diagnosed with Parkinson's
disease.  She lives in [**Hospital1 614**] with the children, but he sees
them once or twice a month.  He has been married for a second
time for the last two years.  He appears to have a strong and
supportive relationship with his second wife.


Family History:
His family history is noteworthy for the fact that his mother
had
heart disease, ovarian cancer, and adult onset diabetes, and
passed away at age 62.  His father is 71 years old and has a
history of prostate cancer, hypertension, and polymyalgia
rheumatica. His brother (age 47) has no known medical history.
Both of his sisters (age 49 & 33) have Crohn's disease. There is
no known family history of Parkinson's disease or other
neurologic disorders.


Physical Exam:
On Discharge:HE has no cranial nerve deficit or motor or sensory
deficit. He has a surgical bandage which is clean and dry.

Pertinent Results:
CT head [**2172-2-11**]:
No evidence of large intracranial hemorrhage, however, study is
suboptimal due to extensive streak artifacts generated by DBS
electrodes. The electrode leads likely terminate in the
subthalamic nuclei bilaterally, more precise location of the
leads may be determined by MR, if clinically indicated.


Brief Hospital Course:
Mr. [**Known lastname 66595**] was admitted to [**Hospital1 18**] on [**2172-2-11**]. He had the frame
placed in pre-op. He had an MRI. He was taken to the OR and had
a bilateral Stage 1 DBS placement. He was transferred to the
PACU. CT head showed no hemorrhage. He was requiring prn
hydralazine and Lopressor for SBP>140. A Cardene drip was
started and he was transferred to the SICU. He remained stable
overnight. His diet was advanced. His [**State 2690**] catheter was
discontinued. He had a mild episode of word finding difficulty
and memory problems that resolved. We discussed this with Dr.
[**First Name (STitle) **]. She was not concerned for a seizure and he was discharged
to home on [**2172-2-12**].

Medications on Admission:
amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
pramipexole 0.5 mg Tablet Sig: One (1) Tablet PO Q3hrs ().
Stalevo 100 25-100-200 mg Tablet Sig: One (1) Tablet PO Q3hr ().

carbidopa-levodopa 25-100 mg Tablet Sig: One (1) Tablet PO Q3H
(every 3 hours).
carbidopa-levodopa 25-100 mg Tablet Sig: [**1-5**] tab Tablet PO Q3PM
().
carbidopa-levodopa 25-100 mg Tablet Sig: [**1-5**] tab Tablet PO QNOON
().


Discharge Medications:
1. amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
2. pramipexole 0.5 mg Tablet Sig: One (1) Tablet PO Q3hrs ().
3. Stalevo 100 25-100-200 mg Tablet Sig: One (1) Tablet PO Q3hr
().
4. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain/temp/ha.
5. carbidopa-levodopa 25-100 mg Tablet Sig: One (1) Tablet PO
Q3H (every 3 hours).
6. carbidopa-levodopa 25-100 mg Tablet Sig: [**1-5**] tab Tablet PO
Q3PM ().
7. carbidopa-levodopa 25-100 mg Tablet Sig: [**1-5**] tab Tablet PO
QNOON ().
8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
9. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Parkinson's Diseas

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


Discharge Instructions:
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 only after sutures have been removed.
??????	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.
??????	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 call ([**Telephone/Fax (1) 88**] if you have questions about your
Stage 2 procedure.


                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

Completed by:[**2172-2-12**]
{'Paralysis agitans,Unspecified essential hypertension'}


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: Parkinson's Disease

PRESENT ILLNESS: Mr. [**Known lastname 66595**] is a young 36 year old male with Parkinson's disease
diagnosed in [**2165**]. Onset of symptoms was on the left side. His
presenting symptom was difficulty with left arm swing and
shoulder pain. His symptoms have progressed to involve both
sides, although still they are slightly asymmetric
with left-sided involved more than the right. He has major
problems with
rigidity and muscle cramping, bradykinesias, gait disorder,
freezing. He has no problems with tremor. He has minor problems
with dystonia as well as poor balance, dysarthria, hypophonia,
stooped posture and swallowing trouble. He
needs assistance to ambulate when he is off. Usually he needs to
hold on to somebody to support himself. Overall, 50% of the day
he is not able to function.

MEDICAL HISTORY: Parkinson's disease

MEDICATION ON ADMISSION: amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
pramipexole 0.5 mg Tablet Sig: One (1) Tablet PO Q3hrs ().
Stalevo 100 25-100-200 mg Tablet Sig: One (1) Tablet PO Q3hr ().

ALLERGIES: Penicillins / Erythromycin Base / Shellfish

PHYSICAL EXAM: On Discharge:HE has no cranial nerve deficit or motor or sensory
deficit. He has a surgical bandage which is clean and dry.

FAMILY HISTORY: His family history is noteworthy for the fact that his mother
had
heart disease, ovarian cancer, and adult onset diabetes, and
passed away at age 62.  His father is 71 years old and has a
history of prostate cancer, hypertension, and polymyalgia
rheumatica. His brother (age 47) has no known medical history.
Both of his sisters (age 49 & 33) have Crohn's disease. There is
no known family history of Parkinson's disease or other
neurologic disorders.

SOCIAL HISTORY: Mr. [**Known lastname 66595**] was born and raised in [**Location (un) 66596**], [**State 350**].
His wife reported that his mother had gestational diabetes, and
that Mr. [**Known lastname 66595**] was born 10 ?????? weeks premature with no
complications at birth, and that he met developmental milestones
at a normal rate. He stated that he attended public schools and
he did well.  He attended [**First Name4 (NamePattern1) 6930**] [**Last Name (NamePattern1) **] College where he
studied environmental science and graduated in [**2157**].  He worked
in a biotech company producing monoclonal antibodies, but has
not worked for several years.  He has been married twice.  His
first marriage lasted 14 years and he has two children (daughter
age 11, and son age 6) from that marriage.  His former wife
apparently left him when he was diagnosed with Parkinson's
disease.  She lives in [**Hospital1 614**] with the children, but he sees
them once or twice a month.  He has been married for a second
time for the last two years.  He appears to have a strong and
supportive relationship with his second wife. 

### Response:
{'Paralysis agitans,Unspecified essential hypertension'}
