CHIEF COMPLAINT: Brain tumor

PRESENT ILLNESS: The patient is a 60-year-old male who is well-
known to our service from a previous admission and
stereotactic brain biopsy. The patient had after trauma and
incidentally diagnosed brain tumor. The tumor was largely
asymptomatic initially and underwent a stereotactic biopsy.
This revealed subependymoma. The patient recently became
symptomatic with progressive headaches and it was felt that
ventricular entrapment contributed to this particular
situation. The patient was therefore extensively counseled.
The patient wished to undergo surgical decompression to
decrease his risk in the future and allow for better
treatment options in the future.

MEDICAL HISTORY: DM type II
CAD
hyperchol.
arthritis
kidney stones
right inguinal lipoma removal
left shoulder repair
laser kidney stone procedure

MEDICATION ON ADMISSION: Atenolol 100 mg po daily, metformin 1,000 mg po
twice daily, Byetta 10 microgram per 0.4 cc twice daily,
diltiazem 240 mg po daily, atorvastatin 20 mg po daily, and
Embrel 50 mg po q week

ALLERGIES: Codeine

PHYSICAL EXAM: He is awake, alert, and oriented times 3. His language is fluent

FAMILY HISTORY: NC

SOCIAL HISTORY: denies tobacco
minimal EtOH use
works as engineer at [**Company 2676**]
Neoplasm of uncertain behavior of brain and spinal cord,Subendocardial infarction, initial episode of care,Psoriatic arthropathy,Acute diastolic heart failure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery
Unc beh neo brain/spinal,Subendo infarct, initial,Psoriatic arthropathy,Ac diastolic hrt failure,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Hypertension NOS,Crnry athrscl natve vssl
Admission Date:  [**2140-12-14**]              Discharge Date:   [**2140-12-22**]

Date of Birth:  [**2080-2-3**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Codeine

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Brain tumor

Major Surgical or Invasive Procedure:
Craniotomy for tumor resection


History of Present Illness:
The patient is a 60-year-old male who is well-
known to our service from a previous admission and
stereotactic brain biopsy. The patient had after trauma and
incidentally diagnosed brain tumor. The tumor was largely
asymptomatic initially and underwent a stereotactic biopsy.
This revealed subependymoma. The patient recently became
symptomatic with progressive headaches and it was felt that
ventricular entrapment contributed to this particular
situation. The patient was therefore extensively counseled.
The patient wished to undergo surgical decompression to
decrease his risk in the future and allow for better
treatment options in the future.


Past Medical History:
DM type II
CAD
hyperchol.
arthritis
kidney stones
right inguinal lipoma removal
left shoulder repair
laser kidney stone procedure


Social History:
denies tobacco
minimal EtOH use
works as engineer at [**Company 2676**]


Family History:
NC


Physical Exam:
He is awake, alert, and oriented times 3. His language is fluent

with good comprehension. His 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; there is

no nystagmus or saccadic intrusions. Visual fields are full to
confrontation. Funduscopic examination reveals sharp disks
margins bilaterally. 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
[**5-7**] at all muscle groups. His muscle tone is normal. His
reflexes are 0-1 bilaterally. His ankle jerks are absent. His
toes are downgoing. Sensory examination is intact to touch and
proprioception. Coordination examination does not reveal
dysmetria. His gait is normal. He does not have a Romberg.


Pertinent Results:
[**2140-12-19**] 04:44AM BLOOD WBC-15.0* RBC-4.88 Hgb-15.7 Hct-45.2
MCV-93 MCH-32.3* MCHC-34.8 RDW-13.7 Plt Ct-360
[**2140-12-19**] 04:44AM BLOOD Plt Ct-360
[**2140-12-19**] 04:44AM BLOOD Glucose-144* UreaN-26* Creat-0.7 Na-137
K-4.3 Cl-104 HCO3-23 AnGap-14
[**2140-12-18**] 02:22PM BLOOD CK(CPK)-20*
[**2140-12-18**] 02:22PM BLOOD CK-MB-NotDone cTropnT-0.12*
[**2140-12-19**] 04:44AM BLOOD Albumin-3.4 Calcium-8.7 Phos-4.0 Mg-2.0
[**2140-12-16**] 03:52AM BLOOD TSH-0.26*
[**2140-12-19**] 04:44AM BLOOD Phenyto-7.9*
[**2140-12-16**] 04:08AM BLOOD Lactate-2.3*
[**2140-12-16**] 04:04AM BLOOD O2 Sat-93
[**2140-12-16**] 04:08AM BLOOD freeCa-1.10*

EKG [**12-19**] Atrial fibrillation with rapid ventricular response.
Since the previous tracing earlier on [**2140-12-16**] no change.

Echo: [**12-16**] : Findings
LEFT ATRIUM: Normal LA size.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size.

LEFT VENTRICLE: Moderate symmetric LVH. Small LV cavity.
Suboptimal technical quality, a focal LV wall motion abnormality
cannot be fully excluded. Overall normal LVEF (>55%). No resting
LVOT gradient. No VSD.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Focal
calcifications in aortic root. Normal ascending aorta diameter.
Focal calcifications in ascending aorta. Normal aortic arch
diameter. Focal calcifications in aortic arch.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP.
Mild mitral annular calcification. Mild thickening of mitral
valve chordae. Calcified tips of papillary muscles. No MS.
Trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR. Normal tricuspid valve supporting structures. No TS.
Indeterminate PA systolic pressure.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with physiologic PR. Normal main PA. No Doppler evidence for PDA


PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Suboptimal image quality - poor echo windows.
Suboptimal image quality - poor parasternal views. Suboptimal
image quality - poor apical views.
Conclusions
The left atrium is normal in size. There is moderate symmetric
left ventricular hypertrophy. The left ventricular cavity is
small. Due to suboptimal technical quality, a focal wall motion
abnormality cannot be fully excluded. Overall left ventricular
systolic function is normal (LVEF 70%). There is no ventricular
septal defect. Right ventricular chamber size and free wall
motion are normal. There are focal calcifications in the aortic
arch. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. No aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. There is no
mitral valve prolapse. Trivial mitral regurgitation is seen. The
pulmonary artery systolic pressure could not be determined

MRI of brain: Residual mass within the left lateral ventricle
demonstrates patchy enhancement that has decreased in size
compared to the preoperative study, now measuring approximately
2.7 x 1.8 x 1.8 cm, previously 2.9 x 2.2 x 2.8 cm. There is a
new tract that extends through the left frontal lobe to the left
lateral ventricle with surrounding signal abnormality and
enhancement. There is post op pneumocephalus. Extraaxial
fluid/blood products are also present, and presumably
postoperative. No new masses are identified. There is mild
ethmoid mucosal thickening.




Brief Hospital Course:
Mr [**Known lastname **] was admitted electively for a endoscopic craniotomy for
tumor resection.  Post operatively he was noted to have some
expressive aphasia.  A CT showed no hemorrhage, he spent
overnight in the PACU was started on Decadron. His BP was kept
less than 140 overnight.  On POD#1 he was transferred to the
surgical floor and later that evening he went into atrial
fibrillation with rapid ventricular response thought to be
related to hypervolemia.  He was transferred to the surgical ICU
and started on a Cardiazem drip.  on [**12-16**] CTA chest showed
consolidation in the lower lobes bilaterally as well as less
prominent in the upper lobes. The distribution is suggestive of
aspiration pneumonia. no PE, no DVT was seen on lower extremity
dopplers. An Echo showed an EF 70%, LV and RV nrml, valves nrml.
 He ruled in for an MI by troponin.  He was started on beta
blockers (already on Metoprolol)and a statin.  His Cardiazem po
was titrated while the drip was weaned.  He remained
neurologically stable with the exception of expressive aphasia.
[**12-15**] MRI Head: Residual tumor in the left lateral ventricle.
On [**12-20**] he was transferred to the neuro step-down unit. The
patient remained neurologically stable, was eating, and
ambulating. He had difficulty voiding and required a new foley
catheter.  Bladder training was started and it was successfully
removed on [**12-22**].  His staples were also removed on discharge,
the site was clean and dry.


Medications on Admission:
Atenolol 100 mg po daily, metformin 1,000 mg po
twice daily, Byetta 10 microgram per 0.4 cc twice daily,
diltiazem 240 mg po daily, atorvastatin 20 mg po daily, and
Embrel 50 mg po q week

Discharge Medications:
1. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day:
use while on pain medication.
Disp:*60 Capsule(s)* Refills:*0*
2. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
3. Atorvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
4. Byetta 5 mcg/0.02 mL Pen Injector Sig: One (1) ML
Subcutaneous [**Hospital1 **] (2 times a day) as needed for give when pt is
on po diet.
5. B-Complex with Vitamin C     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours): use
while on Decadron.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
8. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule
PO BID (2 times a day).
Disp:*120 Capsule(s)* Refills:*2*
9. Diltiazem HCl 90 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
Disp:*120 Tablet(s)* Refills:*2*
10. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours).
Disp:*60 Tablet(s)* Refills:*2*
11. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] visiting nurse assoc

Discharge Diagnosis:
Brain tumor
NSTEMI
CHF / acute diastolic dysfunction
diabetes
post operative urinary retention
hypercholesterolemia
atrial fibrillation with RVR


Discharge Condition:
Neurologically stable.


Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR CRANIOTOMY/HEAD INJURY

??????	Have a 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,
excessive bending
??????	You may wash your hair only after sutures and/or staples have
been removed
??????	You may shower before this time with assistance and use of a
shower cap
??????	Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit

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


Followup Instructions:
Please call Dr. [**Last Name (STitle) **] / cardiology for an appointment to be
seen for follow up of your Atrial fibrillation and myocardia
infarction, Congestive heart failure at [**Telephone/Fax (1) 2386**]. you should
be seen within 2 weeks of discharge.
PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH
DR.[**Last Name (STitle) **] TO BE SEEN IN 4 WEEKS.

YOU ALSO HAVE FOLLOWING APPOINTMENTS:
Provider [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) 4861**], MD Phone:[**Telephone/Fax (1) 1844**] Date/Time:[**2141-1-16**]
9:30
Provider: [**Name10 (NameIs) 706**] MRI Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2141-1-16**]
7:55

Out patient occupational therapy



Completed by:[**2140-12-22**]
{'Neoplasm of uncertain behavior of brain and spinal cord,Subendocardial infarction, initial episode of care,Psoriatic arthropathy,Acute diastolic heart failure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery'}


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: Brain tumor

PRESENT ILLNESS: The patient is a 60-year-old male who is well-
known to our service from a previous admission and
stereotactic brain biopsy. The patient had after trauma and
incidentally diagnosed brain tumor. The tumor was largely
asymptomatic initially and underwent a stereotactic biopsy.
This revealed subependymoma. The patient recently became
symptomatic with progressive headaches and it was felt that
ventricular entrapment contributed to this particular
situation. The patient was therefore extensively counseled.
The patient wished to undergo surgical decompression to
decrease his risk in the future and allow for better
treatment options in the future.

MEDICAL HISTORY: DM type II
CAD
hyperchol.
arthritis
kidney stones
right inguinal lipoma removal
left shoulder repair
laser kidney stone procedure

MEDICATION ON ADMISSION: Atenolol 100 mg po daily, metformin 1,000 mg po
twice daily, Byetta 10 microgram per 0.4 cc twice daily,
diltiazem 240 mg po daily, atorvastatin 20 mg po daily, and
Embrel 50 mg po q week

ALLERGIES: Codeine

PHYSICAL EXAM: He is awake, alert, and oriented times 3. His language is fluent

FAMILY HISTORY: NC

SOCIAL HISTORY: denies tobacco
minimal EtOH use
works as engineer at [**Company 2676**] 

### Response:
{'Neoplasm of uncertain behavior of brain and spinal cord,Subendocardial infarction, initial episode of care,Psoriatic arthropathy,Acute diastolic heart failure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery'}
