CHIEF COMPLAINT: Status Epilepticus

PRESENT ILLNESS: 33 yo M with h/o seizure disorder (complex partial and GTC
seizures) including history of status epilepticus admitted today
with status epilepticus.

MEDICAL HISTORY: Seizures since 8 yrs of age with semiology as above.  Per mother
she thinks they are due to hypoxic injury at birth due to cord
around his neck and he was blue.  Prior MRI in [**2157**] showed 2
enhancing lesions L occipital lobe of unknown etiology but
stable
for years. Was in status epilepticus, intubated 10 years ago
while in college. Note he has had cognitive and mood side
effects
with many of his AEDs, thus the reason for tapering keppra and
lacosamide recently.

MEDICATION ON ADMISSION: - Keppra 1500mg po bid as of last neuro visit [**2161-4-7**] but
planned
for taper
- Lamictal 600mg daily
- Lacosamide 500mg daily as of [**4-7**] but planned taper
- Ativan 1mg po bid
- fluoxetine 20 mg po daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ON ADMISSION:
T101 HR 72 BP 108/62 O2 100%.  Intubated and sedated.
gen - NAD
HEENT - NCAT, no clear trauma, could not fully assess orpharynx
due to ETT and oral airway in place.
Neck - not assessed because c-spine not cleared
CV - RRR, no m/r/g
Resp - good aeration bilat
Skin - no rashes
Neurologic exam
  MS - Grimaces to pain.  Does not follow commands
  CN - PERRL 4-->2mm, could not assess doll's eyes due to
c-spine, + corneals, +grimace to nasal tickle, + gag.
  Motor - Normal tone.  Withdraws all extremities to pain,
antigravity at least in upper extremities.  DTRs 2+ symmetric
[**Hospital1 **],
tri, bracheoradialis, knees and ankles.  Toes upgoing on the R
and mute on the L.
  Sensory - withdraws to painful stimuli.

FAMILY HISTORY: - positive for diabetes (brother)
- negative for seizures and other neurological abnormalities.

SOCIAL HISTORY: - Lives alone.
- previously worked as a research associate at Mom[**Name (NI) **]
Pharmaceuticals, but has been on medical leave for two months
because of his seizures.
- the second youngest of five brothers
- sadly, his father was killed in the World Trade Center on
[**8-8**].
Epilepsia partialis continua, without mention of intractable epilepsy,Acute respiratory failure,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Accidents caused by other specified cutting and piercing instruments or objects
Epil par cont w/o int ep,Acute respiratry failure,Open wnd knee/leg/ankle,Acc-cutting instrum NEC
Admission Date:  [**2161-4-15**]              Discharge Date:   [**2161-4-22**]

Date of Birth:  [**2127-10-24**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7575**]
Chief Complaint:
Status Epilepticus


Major Surgical or Invasive Procedure:
* Arrived intubated

History of Present Illness:
33 yo M with h/o seizure disorder (complex partial and GTC
seizures) including history of status epilepticus admitted today
with status epilepticus.

At baseline he has 2 seizure types per his mother at bedside.
1) Wandering around, facial twitching (unilateral but either
side) and pill rolling movement of one side (either side)
typically lasting minutes and occuring recently a couple of
times
per day.
2) Generalized shaking and unresponsiveness.  Every several
months, last ~5 months ago.

He lives alone.  Today he was at home alone.  He called EMS and
was confused.  The EMTs arrived and found him confused and
bleeding from L leg and foot.  They thought he had fallen
through
a glass table.  No obvious head or neck trauma.  He was taken to
ED in [**Hospital1 392**] initially.  There he was having seizures, though
not
clearly described.  He received a total of 22mg ativan and 500mg
dilantin.  He was intubated and sedated with propofol.  He was
transported to our ED by ambulance.  On arrival here he was
sedated on propofol.  When propofol was stopped for ~5 min for
exam, he began having full body coarse tremor concerning for
seizure.  This stopped when propofol restarted.  With propofol
on
he would withdraw to painful stimuli but not follow commands.

Neurology consulted to help with management of seizures.

He was given an additional 500mg dilantin and a 1g keppra load
per our recommendations.

ROS: Per mother no recent illnesses, no fevers.  She had seen
him
the night before and he was well.  No prior trauma.


Past Medical History:
Seizures since 8 yrs of age with semiology as above.  Per mother
she thinks they are due to hypoxic injury at birth due to cord
around his neck and he was blue.  Prior MRI in [**2157**] showed 2
enhancing lesions L occipital lobe of unknown etiology but
stable
for years. Was in status epilepticus, intubated 10 years ago
while in college. Note he has had cognitive and mood side
effects
with many of his AEDs, thus the reason for tapering keppra and
lacosamide recently.


Social History:
- Lives alone.
- previously worked as a research associate at Mom[**Name (NI) **]
Pharmaceuticals, but has been on medical leave for two months
because of his seizures.
- the second youngest of five brothers
- sadly, his father was killed in the World Trade Center on
[**8-8**].


Family History:
- positive for diabetes (brother)
- negative for seizures and other neurological abnormalities.

Physical Exam:
ON ADMISSION:
T101 HR 72 BP 108/62 O2 100%.  Intubated and sedated.
gen - NAD
HEENT - NCAT, no clear trauma, could not fully assess orpharynx
due to ETT and oral airway in place.
Neck - not assessed because c-spine not cleared
CV - RRR, no m/r/g
Resp - good aeration bilat
Skin - no rashes
Neurologic exam
  MS - Grimaces to pain.  Does not follow commands
  CN - PERRL 4-->2mm, could not assess doll's eyes due to
c-spine, + corneals, +grimace to nasal tickle, + gag.
  Motor - Normal tone.  Withdraws all extremities to pain,
antigravity at least in upper extremities.  DTRs 2+ symmetric
[**Hospital1 **],
tri, bracheoradialis, knees and ankles.  Toes upgoing on the R
and mute on the L.
  Sensory - withdraws to painful stimuli.


Pertinent Results:
Admission Labs ([**2161-4-15**]):
WBC-10.7 RBC-4.13* HGB-13.1* HCT-37.6* MCV-91 MCH-31.6 PLT-228
NEUTS-86.4* LYMPHS-7.9* MONOS-5.5 EOS-0.2 BASOS-0.1
GLUCOSE-83 UREA N-12 CREAT-1.2 SODIUM-140 POTASSIUM-3.8
CHLORIDE-106 TOTAL CO2-23 ANION GAP-15
CALCIUM-7.4* PHOSPHATE-2.8 MAGNESIUM-2.4
CK(CPK)-3623*
ASA-NEG ETHANOL-NEG CARBAMZPN-<0.5 ACETMNPHN-NEG bnzodzpn-NEG
barbitrt-NEG tricyclic-NEG
.
URINE  bnzodzpn-NEG barbitrt-NEG opiates-POS cocaine-NEG
amphetmn-NEG mthdone-NEG
.
CEREBROSPINAL FLUID (CSF)  PROTEIN-25 GLUCOSE-71
CEREBROSPINAL FLUID (CSF)  WBC-2 RBC-18* POLYS-81 LYMPHS-8
MONOS-8 ATYPS-3
CEREBROSPINAL FLUID (CSF)  WBC-3 RBC-11* POLYS-96 BANDS-1
LYMPHS-0 MONOS-3
CEREBROSPINAL FLUID (CSF)  HERPES SIMPLEX VIRUS PCR-Negative
CEREBROSPINAL FLUID (CSF): gram stain negative
.
Blood Culture: negative
.
Pertinent Labs ([**2161-4-22**]): CK 1186 - persistently trending down
toward normal range
.
TELEMETRY:
.
EEG ([**2161-4-15**]):
IMPRESSION: This telemetry captured no pushbutton activations
and no
ongoing seizure activity. Interictally, there were epileptic
discharges
seen mainly in the left temporal region but also more
infrequently in
the right frontal area. The baseline was abnormal comprised of
periods
of suppression of the baseline and mixed frequency activity and
suggesting a moderate to severe encephalopathy.
.
EEG ([**Date range (1) 33871**]):
IMPRESSION: This telemetry captured no pushbutton activations
and no
ongoing seizure activity. Interictally, there are a few sharp
discharges seen in the right fronto-temporal region as well as
independently in the left temporal area. The background activity
was
intermixed with slow activity suggestive of diffuse mild
encephalopathy.
The excessive beta activity suggests a medication effect. The
focal
slowing in the left temporal area suggests a subcortical
dysfunction in
this region. Of note is that marked improvement is seen in
comparison
to the previous day's study.
.
EEG ([**Date range (1) 19628**]):
IMPRESSION: This telemetry captured no pushbutton activations
and no
ongoing seizure activity. Interictally, there were independent
discharges, many in the left temporal but also in the right
central
temporal region. There was focal slowing seen in the left
temporal area
suggestive of subcortical dysfunction in the region. The
background
activity was slow suggestive of mild encephalopathy. The
excessive beta
activity suggests medication effect.
.
EEG ([**Date range (1) 33872**]):
IMPRESSION: This telemetry captured no pushbutton activations.
Routine
sampling showed a normal background in wakefulness and in sleep.
There
were several left temporal discharges seen in isolation, and
there were
two right temporal sharp waves, as well.
.
EEG ([**Date range (1) 33873**]):
IMPRESSION: This telemetry captured no pushbutton activations.
Routine
sampling showed a normal background in wakefulness and in sleep,
with
minimal left temporal theta slowing admixed at times. There were
about
eight isolated left temporal sharp wave discharges seen on
automated
spike detection programs.
.
EEG ([**Date range (1) 33874**]):
IMPRESSION: This telemetry captured no pushbutton activations.
Routine
sampling showed a normal background in wakefulness and in sleep.
There
were two left temporal sharp wave discharges captured
automatically.
There were no electrographic seizures.
.
EEG ([**4-22**]):
IMPRESSION: This is a normal non-continous extended routine EEG.
This
telemetry captured no pushbutton activations. The interictal
background
activity was normal during this study.
 .
Non-Contrast CT Head ([**2161-4-15**]):
IMPRESSION:
No acute intracranial process.
.
Non-Contrast CT Cervical Spine ([**2161-4-15**]):
IMPRESSION: No fracture or subluxation.
.
Plain Films Left Knee ([**2161-4-15**]):
IMPRESSION: No fracture, dislocation, or foreign body.
.


Brief Hospital Course:
Mr. [**Known lastname **] is a very [**Last Name (un) 1425**] 33 year-old man with a past medical
history including epilepsy who was transferred to the [**Hospital1 18**] ICU
in presumed status epilepticus.  He was admitted to the general
neurology service from [**2161-4-15**] to [**2161-4-22**].
.
As the patient was found to be febrile upon arrival in the ED, a
lumbar puncture was performed.  The cerebrospinal profile was
unrevealing.  Gram stain and culture were negative, as was an
assay for HSV.  Blood cultures also returned negative.
Additional investigatory studies failed to reveal clearly
contributory toxic and metabolic processes.
.
To evaluate for structural lesions, and complications of
apparent trauma, a non-contrast CT of the head was performed.
The study was interpreted as negative.  In the context of
trauma, a CT of the cervical spine was also done and found to be
negative for fracture and subluxation.  Plain films of the left
knee showed no injury sustained in a fall through glass.
.
At the time of admission, long-term electroencephalogram (EEG)
monitoring was initiated.  The telemetry demonstrated no ongoing
seizure activity.  The recordings variably demonstrated
discharges in the left temporal, right frontal, and right
temporal regions.  While Mr. [**Known lastname **] was clinically and
electrographically encephalopathic in the first one to two days
following admission, he and his mother shared that he improved
to his baseline mental status prior to discharge.
.
In the course of the admission, several medication changes were
made in an attempt to optimize the anti-epileptic drug regimen.
The lacosamide was discontinued.  Trileptal was added.  The
total daily dose of ativan was increased by 1 mg (and is now
prescribed in a regimen of 0.5 mg by mouth in the morning, 0.5
mg by mouth at 12 noon, and 1 mg by mouth at bedtime).  Lamictal
was continued at prior outpatient doses.   Although the
long-term goal is to discontinue keppra, the outpatient regimen
was maintained in the setting of such a significant presenting
event.  Mr. [**Known lastname **] [**Last Name (Titles) 8337**] the medication changes well, and
there was an observed improvement in the EEG recordings; on the
day of discharge, the EEG appeared normal.  The hope is to plan
an epilepsy surgery evaluation within the next year.
.
Mr. [**Known lastname **] was discharged home.



Medications on Admission:
- Keppra 1500mg po bid as of last neuro visit [**2161-4-7**] but
planned
for taper
- Lamictal 600mg daily
- Lacosamide 500mg daily as of [**4-7**] but planned taper
- Ativan 1mg po bid
- fluoxetine 20 mg po daily


Discharge Medications:
1. Lamotrigine 100 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
Disp:*180 Tablet(s)* Refills:*2*
2. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
3. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
Disp:*30 Tablet(s)* Refills:*2*
4. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO twice a day:
Take 1 tab by mouth once in the morning and once at 12 noon.
Disp:*60 Tablet(s)* Refills:*2*
5. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
6. Oxcarbazepine 600 mg Tablet Sig: One (1) Tablet PO QAM.
Disp:*30 Tablet(s)* Refills:*2*
7. Oxcarbazepine 300 mg Tablet Sig: Three (3) Tablet PO QPM
(once a day (in the evening)).
Disp:*90 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Status Epilepticus


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
The neurological examination is non-focal.  He does have a
postural tremor.


Discharge Instructions:
You were transferred to the [**Hospital1 18**] ICU in status epilepticus.
Long-term electroencephalogram (EEG) monitoring was initiated,
and  demonstrated the discontinuation of ongoing seizure
activity.  Although initially confused, you were alert and
interactive by the day of discharge.
.
There does not seem to have been a precipitant for the
presenting event.  Investigatory studies show no clearly
contributory toxic, metabolic, infectious, or structural
processes.
.
Please note that several medication changes have been made:
- The lacosamide was discontinued.
- Treliptal was added.
- The total daily dose of ativan was increased by 1 mg (and is
now prescribed in a regimen of 0.5 mg by mouth in the morning,
0.5 mg by mouth at 12 noon, and 1 mg by mouth at bedtime).
- The lamictal and keppra doses are UNCHANGED.
.
Please continue to exercise seizure precautions.  It will be
important to refrain from driving until you have been
seizure-free for at least six months.  Please do not climb to
heights from which you might be at risk of falling.  Please do
notgo swimming independently.
.
* Please take all medications as prescribed.
* Please attend all follow-up appointments.
* Please seek medical attention if you develop confusion,
trouble speaking, difficulty seeing, weakness or sensory changes
- especially in one side of the body, shaking of the limbs, or
any other symptom you find concerning.

Followup Instructions:
* Please coordinate an appointment with primary care physician
[**Last Name (NamePattern4) **]. [**Last Name (STitle) **] (Phone: [**Telephone/Fax (1) 250**]) in one to two weeks.
* Please attend an appointment with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 2442**]
([**Telephone/Fax (1) 3506**]) on [**2161-6-2**] at 9:00 am.
{'Epilepsia partialis continua, without mention of intractable epilepsy,Acute respiratory failure,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Accidents caused by other specified cutting and piercing instruments or objects'}


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: Status Epilepticus

PRESENT ILLNESS: 33 yo M with h/o seizure disorder (complex partial and GTC
seizures) including history of status epilepticus admitted today
with status epilepticus.

MEDICAL HISTORY: Seizures since 8 yrs of age with semiology as above.  Per mother
she thinks they are due to hypoxic injury at birth due to cord
around his neck and he was blue.  Prior MRI in [**2157**] showed 2
enhancing lesions L occipital lobe of unknown etiology but
stable
for years. Was in status epilepticus, intubated 10 years ago
while in college. Note he has had cognitive and mood side
effects
with many of his AEDs, thus the reason for tapering keppra and
lacosamide recently.

MEDICATION ON ADMISSION: - Keppra 1500mg po bid as of last neuro visit [**2161-4-7**] but
planned
for taper
- Lamictal 600mg daily
- Lacosamide 500mg daily as of [**4-7**] but planned taper
- Ativan 1mg po bid
- fluoxetine 20 mg po daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ON ADMISSION:
T101 HR 72 BP 108/62 O2 100%.  Intubated and sedated.
gen - NAD
HEENT - NCAT, no clear trauma, could not fully assess orpharynx
due to ETT and oral airway in place.
Neck - not assessed because c-spine not cleared
CV - RRR, no m/r/g
Resp - good aeration bilat
Skin - no rashes
Neurologic exam
  MS - Grimaces to pain.  Does not follow commands
  CN - PERRL 4-->2mm, could not assess doll's eyes due to
c-spine, + corneals, +grimace to nasal tickle, + gag.
  Motor - Normal tone.  Withdraws all extremities to pain,
antigravity at least in upper extremities.  DTRs 2+ symmetric
[**Hospital1 **],
tri, bracheoradialis, knees and ankles.  Toes upgoing on the R
and mute on the L.
  Sensory - withdraws to painful stimuli.

FAMILY HISTORY: - positive for diabetes (brother)
- negative for seizures and other neurological abnormalities.

SOCIAL HISTORY: - Lives alone.
- previously worked as a research associate at Mom[**Name (NI) **]
Pharmaceuticals, but has been on medical leave for two months
because of his seizures.
- the second youngest of five brothers
- sadly, his father was killed in the World Trade Center on
[**8-8**]. 

### Response:
{'Epilepsia partialis continua, without mention of intractable epilepsy,Acute respiratory failure,Open wound of knee, leg [except thigh], and ankle, without mention of complication,Accidents caused by other specified cutting and piercing instruments or objects'}
