CHIEF COMPLAINT: Heaches, Double Vision

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 70 year old female with a history of breast
cancer who was experiencing occipital and frontal headaches and
double vision for two days. A head CT was done at an OSH
revealing a right posterior fossa lesion with mass effect. She
reports the headaches were intermittent in the right occipital
area. She also reports some nausea mainly at night. She also
felt
like she had poor control while walking.

MEDICAL HISTORY: Breast cancer- diagnosed [**2189**]
L lumpectomy followed by a left mastectomy
Chemo- Xeloda?
Cardiac complications post-chemo per patient
UTIs and urinary urgency
s/p hysterectomy
s/p bladder suspension surgery

MEDICATION ON ADMISSION: Lisinopril
Digoxin
Fluticasone
Lasix
Nizatidine
Metoprolol Tartrate
Ativan PRN

ALLERGIES: Latex / Penicillins / Tetracycline / Erythromycin Base / Sulfa
(Sulfonamides) / Robitussin-Cf / Iodine / Mold Extracts

PHYSICAL EXAM: PHYSICAL EXAM:
O: T: 97.8  BP: /     HR: 82   R 12       O2Sats 99% RA

FAMILY HISTORY: Denies any significant family history. Reports grandmother is
deceased from cancer but unsure of what type.

SOCIAL HISTORY: Lives with husband. Retired. Nonsmoker. Denies any alcohol or
recreational drug use.
Secondary malignant neoplasm of brain and spinal cord,Compression of brain,Chronic systolic heart failure,Secondary cardiomyopathy, unspecified,Personal history of malignant neoplasm of breast,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use
Sec mal neo brain/spine,Compression of brain,Chr systolic hrt failure,Second cardiomyopath NOS,Hx of breast malignancy,Adv eff antineoplastic
Admission Date:  [**2196-2-1**]              Discharge Date:   [**2196-2-8**]

Date of Birth:  [**2125-10-6**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Latex / Penicillins / Tetracycline / Erythromycin Base / Sulfa
(Sulfonamides) / Robitussin-Cf / Iodine / Mold Extracts

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Heaches, Double Vision

Major Surgical or Invasive Procedure:
R suboccipital Crani for Posterior Foassa mass resection
EVD placement


History of Present Illness:
Mrs. [**Known lastname **] is a 70 year old female with a history of breast
cancer who was experiencing occipital and frontal headaches and
double vision for two days. A head CT was done at an OSH
revealing a right posterior fossa lesion with mass effect. She
reports the headaches were intermittent in the right occipital
area. She also reports some nausea mainly at night. She also
felt
like she had poor control while walking.

Past Medical History:
Breast cancer- diagnosed [**2189**]
L lumpectomy followed by a left mastectomy
Chemo- Xeloda?
Cardiac complications post-chemo per patient
UTIs and urinary urgency
s/p hysterectomy
s/p bladder suspension surgery

Social History:
Lives with husband. Retired. Nonsmoker. Denies any alcohol or
recreational drug use.

Family History:
Denies any significant family history. Reports grandmother is
deceased from cancer but unsure of what type.


Physical Exam:
PHYSICAL EXAM:
O: T: 97.8  BP: /     HR: 82   R 12       O2Sats 99% RA

Gen: WD/WN, comfortable, NAD.
HEENT: normocephalic.
Extrem: Warm and well-perfused. 1+ pitting edema to bilateral
ankles

Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: Able to name current president
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3 to 2 mm
bilaterally. Visual fields are full to confrontation.
III, IV, VI: Left 4th nerve palsy
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**3-23**] throughout. No pronator drift

Sensation: Intact to light touch

Coordination: normal on finger-nose-finger, rapid alternating
movements

EXAM ON DISCHARGE;
Same as above.  Decreased diplopia (4th nerve palsey). Incision
clean, dry, and intact.

Pertinent Results:
Admission Labs:

[**2196-2-1**] 06:28PM   SODIUM-140
[**2196-2-1**] 06:28PM   OSMOLAL-305
[**2196-2-1**] 02:30PM   GLUCOSE-98 UREA N-14 CREAT-0.8 SODIUM-141
POTASSIUM-4.4 CHLORIDE-100 TOTAL CO2-30 ANION GAP-15
[**2196-2-1**] 02:30PM   WBC-9.6# RBC-4.82 HGB-13.9 HCT-42.4 MCV-88#
MCH-28.9# MCHC-32.9 RDW-14.2
[**2196-2-1**] 02:30PM   PT-11.6 PTT-28.7 INR(PT)-1.0

Discharge labs:
[**2196-2-7**] 04:49AM BLOOD WBC-14.9* RBC-4.18* Hgb-12.0 Hct-36.1
MCV-86 MCH-28.7 MCHC-33.3 RDW-14.1 Plt Ct-290
[**2196-2-8**] 06:24AM BLOOD Plt Ct-287
[**2196-2-8**] 06:24AM BLOOD Glucose-93 UreaN-21* Creat-0.6 Na-141
K-4.0 Cl-103 HCO3-30 AnGap-12

IMAGING:
MRI [**2-1**]
1. Large mass centered in the inferior lateral aspect of the
right posterior fossa, which may be intra- or extra-axial. If
the lesion is intra-axial, metastatic disease is the main
consideration, especially given the second focus in the
posterior aspect of the right temporal lobe. Metastatic disease
could be a differential consideration if this lesion is
extra-axial as well, though meningioma would also be a
consideration. This however is considered less likely given that
the sigmoid sinus is completely intact and uncompromised by the
mass.

2. There is mass effect on the fourth ventricle as well as mild
tonsillar
herniation and mass effect on the brainstem related to the large
mass and
associated edema from the mass in the right aspect of the
posterior fossa.

Post op Head CT [**2-4**]:
1. Status post right occipital craniectomy and resection of
hyperdense right cerebellar mass, with expected postoperative
pneumocephalus. Small amount of high-density within and
overlying the surgical bed likely represent small amount of
blood products, however, residual tissue from previously
demonstrated hyperdense mass cannot be excluded on the current
study.

2. Mass effect from right cerebellar vasogenic edema is
unchanged, with
partial effacement of the fourth ventricle and right-sided
cerebellar
tonsillar descent.

MRI [**2-5**]:
IMPRESSION: Status post resection of right cerebellar mass
without residual nodular areas of enhancement. Right temporal
tiny enhancing lesion remains as before. No new lesions or acute
infarcts seen. There is mass effect on the fourth ventricle
which has not increased from previous study and there remains
mild dilatation of the ventricles.




Brief Hospital Course:
The patient was admitted to the ICU for Q2 neuro checks, and was
immediately placed on Dexamethasone and Mannitol, 25g Q6 hours.
The work up of this posterior fossa mass continued on HD #1, as
the patient had an MRI and a CT Torso to rule out any further
metastases. She was found to have a cecal mass, and GI was
consulted. They desired doing a perioperative biopsy during her
OR case, however, the patient deferred at that time, desiring
"one procedure first".  Neuro and Radiation oncology were also
consulted. On [**2-4**] she went to the OR for right posterior fossa
for tumor resection. This procedure was tolerated well.  An EVD
was placed prophylactically in the event of significant
post-operative vascogenic edema.

Post operatively, she did well; specifically, her neurologic
exam reamined intact and her diplopia improved.  Her post op
Head CT did not demonstrate any acute hemorrhage.  She was
transferred out of the ICU to the stepdown until on [**2-5**].

She continued to have an improving neurologic exam, as her CN IV
palsey improved slightly. She remained afebrile.  She was
evaluated by Physical Therapy, who determined she was suitable
for discharge to home with PT services. She left for home on
[**2196-2-8**]

Medications on Admission:
Lisinopril
Digoxin
Fluticasone
Lasix
Nizatidine
Metoprolol Tartrate
Ativan PRN


Discharge Medications:
1. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
Spray Nasal DAILY (Daily).
3. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
5. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for pain.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
7. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
8. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
9. Dexamethasone 0.5 mg Tablet Sig: Two (2) Tablet PO Q6 () for
1 days.
Disp:*12 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
Posterior Fossa Mass -Prelim pathology Carcinoma
Systolic CHF with Ejection Fraction of 50%


Discharge Condition:
Stable - A&Ox3


Discharge Instructions:
GENERAL INSTRUCTIONS
WOUND CARE:
??????	You or a family member should inspect your wound every day and
report any of the following problems to your physician.
??????	Keep your incision clean and dry.
??????	You may wash your hair with a mild shampoo 24 hours after your
[**Name (NI) 2729**] are removed.
??????	Do NOT apply any lotions, ointments or other products to your
incision.
??????	DO NOT DRIVE until you are seen at the first follow up
appointment.
??????	Do not lift objects over 10 pounds until approved by your
physician.

DIET
Usually no special diet is prescribed after a craniotomy. A
normal well balanced diet is recommended for recovery, and you
should resume any specially prescribed diet you were eating
before your surgery.  Be sure however, to remain well hydrated,
and increase your consumption of fiber, as pain medications may
cause constipation.

MEDICATIONS:
??????	Take all of your medications as ordered.  You do not have to
take pain medication unless it is needed.  It is important that
you are able to cough, breathe deeply, and is comfortable enough
to walk.
??????	Do not use alcohol while taking pain medication.
??????	Medications that may be prescribed include:
o	Narcotic pain medication such as Dilaudid (hydromorphone).
o	An over the counter stool softener for constipation (Colace or
Docusate). If you become constipated, try products such as
Dulcolax, Milk of Magnesia, first, and then Magnesium Citrate or
Fleets enema if needed). Often times, pain medication and
anesthesia can cause constipation.
??????	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.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc, as this can increase your chances of bleeding.
??????	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.

ACTIVITY:
The first few weeks after you are discharged you may feel tired
or fatigued. This is normal. You should become a little stronger
every day. Activity is the most important measure you can take
to prevent complications and to begin to feel like yourself
again. In general:
??????	Follow the activity instructions given to you by your doctor
and therapist.
??????	Increase your activity slowly; do not do too much because you
are feeling good.
??????	You may resume sexual activity as your tolerance allows.
??????	If you feel light headed or fatigued after increasing
activity, rest, decrease the amount of activity that you do, and
begin building your tolerance to activity more slowly.
??????	DO NOT DRIVE until you speak with your physician.
??????	Do not lift objects over 10 pounds until approved by your
physician.
??????	Avoid any activity that causes you to hold your breath and
push, for example weight lifting, lifting or moving heavy
objects, or straining at stool.
??????	Do your breathing exercises every two hours.
??????	Use your incentive spirometer 10 times every hour,  that you
are awake.

WHEN TO CALL YOUR SURGEON:
With any surgery there are risks of complications. Although your
surgery is over, there is the possibility of some of these
complications developing. These complications include:
infection, blood clots, or neurological changes. Call your
Physician Immediately if you Experience:

??????	Confusion, fainting, blacking out, extreme fatigue, memory
loss, or difficulty speaking.
??????	Double, or blurred vision. Loss of vision, either partial or
total.
??????	Hallucinations
??????	Numbness, tingling, or weakness in your extremities or face.
??????	Stiff neck, and/or a fever of 101.5F or more.
??????	Severe sensitivity to light. (Photophobia)
??????	Severe headache or change in headache.
??????	Seizure
??????	Problems controlling your bowels or bladder.
??????	Productive cough with yellow or green sputum.
??????	Swelling, redness, or tenderness in your calf or thigh.

Call 911 or go to the Nearest Emergency Room if you Experience:
??????	Sudden difficulty in breathing.
??????	New onset of seizure or change in seizure, or seizure from
which you wake up confused.
??????	A seizure that lasts more than 5 minutes.

Important Instructions Regarding Emergencies and After-Hour
Calls
??????	If you have what you feel is a true emergency at any time,
please present immediately to your local emergency room, where a
doctor there will evaluate you and contact us if needed. Due to
the complexity of neurosurgical procedures and treatment of
neurosurgical problems, effective advice regarding emergency
situations cannot be given over the telephone.
??????	Should you have a situation which is not life-threatening, but
you feel needs addressing before normal office hours or on the
weekend, please present to the local emergency room, where the
physician there will evaluate you and contact us if needed.


Followup Instructions:
FOLLOW UP APPOINTMENT INSTRUCTIONS

??????Please return to the office in [**5-28**] days (from your date of
surgery) for removal of your staples/[**Date Range 2729**] and a wound check.
Although we try to be thorough, we may miss [**First Name (Titles) 2730**] [**Last Name (Titles) 2729**] or
staples. Be sure to point out any incisions, which may be
covered by clothing at the time of suture/staple removal. This
appointment can be made with the Nurse Practitioner.  Please
make this appointment by calling [**Telephone/Fax (1) 2731**]. If you live quite
a distance from our office, please make arrangements for the
same, with your PCP.
??????You have an appointment in the Brain [**Hospital 341**] Clinic on [**2-15**].  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) **]. This is a multi-disciplinary
appointment. Their phone number is [**Telephone/Fax (1) 1844**]. Please call if
you need to change your appointment, or require additional
directions.
??????You will not need an MRI of the brain.

Dr. [**Last Name (STitle) 3929**] will contact you when you regarding the date and
time of your radiation oncology appointment.



Completed by:[**2196-2-8**]
{'Secondary malignant neoplasm of brain and spinal cord,Compression of brain,Chronic systolic heart failure,Secondary cardiomyopathy, unspecified,Personal history of malignant neoplasm of breast,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic 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: Heaches, Double Vision

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 70 year old female with a history of breast
cancer who was experiencing occipital and frontal headaches and
double vision for two days. A head CT was done at an OSH
revealing a right posterior fossa lesion with mass effect. She
reports the headaches were intermittent in the right occipital
area. She also reports some nausea mainly at night. She also
felt
like she had poor control while walking.

MEDICAL HISTORY: Breast cancer- diagnosed [**2189**]
L lumpectomy followed by a left mastectomy
Chemo- Xeloda?
Cardiac complications post-chemo per patient
UTIs and urinary urgency
s/p hysterectomy
s/p bladder suspension surgery

MEDICATION ON ADMISSION: Lisinopril
Digoxin
Fluticasone
Lasix
Nizatidine
Metoprolol Tartrate
Ativan PRN

ALLERGIES: Latex / Penicillins / Tetracycline / Erythromycin Base / Sulfa
(Sulfonamides) / Robitussin-Cf / Iodine / Mold Extracts

PHYSICAL EXAM: PHYSICAL EXAM:
O: T: 97.8  BP: /     HR: 82   R 12       O2Sats 99% RA

FAMILY HISTORY: Denies any significant family history. Reports grandmother is
deceased from cancer but unsure of what type.

SOCIAL HISTORY: Lives with husband. Retired. Nonsmoker. Denies any alcohol or
recreational drug use. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Compression of brain,Chronic systolic heart failure,Secondary cardiomyopathy, unspecified,Personal history of malignant neoplasm of breast,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}
