CHIEF COMPLAINT: Headache, confusion

PRESENT ILLNESS: 40 yo female with hx metastatic melanoma (dx [**2136**]) with
multiple recurrences (LNs, lungs, bowel) complains of 1 week of
dull headaches with a few days of confusion and difficulty
concentrating. Denies nausea/vomiting, seizures, weakness,
numbness, paresthesias, problems with vision or balance.

MEDICAL HISTORY: Melanoma course began in [**2136**], mole on back excised.  Recurrence
in R groin, treated with radiation, recurrence in lung, treated
with IL-2, recurrence in colon, partial colectomy. Currently has
nodes in R clavicle and abdomen.

MEDICATION ON ADMISSION: none

ALLERGIES: Naprosyn / Iodine / Adhesive Tape

PHYSICAL EXAM: Upon admission:
Gen: WD/WN, comfortable, NAD, obese.
HEENT: Pupils:   PERRLA      EOMs full
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect, somewhat tearful during interaction.  Occassional
trouble
remembering details of medical history
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: No smoking
Denies alcohol or drugs
Secondary malignant neoplasm of brain and spinal cord,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Personal history of malignant melanoma of skin,Personal history of irradiation, presenting hazards to health
Sec mal neo brain/spine,Mal neo lymph intra-abd,Hx-malig skin melanoma,Hx of irradiation
Admission Date:  [**2145-6-24**]              Discharge Date:   [**2145-6-28**]

Date of Birth:  [**2105-1-19**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Naprosyn / Iodine / Adhesive Tape

Attending:[**First Name3 (LF) 1854**]
Chief Complaint:
Headache, confusion

Major Surgical or Invasive Procedure:
craniotomy for tumor resection

History of Present Illness:
40 yo female with hx metastatic melanoma (dx [**2136**]) with
multiple recurrences (LNs, lungs, bowel) complains of 1 week of
dull headaches with a few days of confusion and difficulty
concentrating. Denies nausea/vomiting, seizures, weakness,
numbness, paresthesias, problems with vision or balance.


Past Medical History:
Melanoma course began in [**2136**], mole on back excised.  Recurrence
in R groin, treated with radiation, recurrence in lung, treated
with IL-2, recurrence in colon, partial colectomy. Currently has
nodes in R clavicle and abdomen.


Social History:
No smoking
Denies alcohol or drugs


Family History:
Noncontributory

Physical Exam:
Upon admission:
Gen: WD/WN, comfortable, NAD, obese.
HEENT: Pupils:   PERRLA      EOMs full
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect, somewhat tearful during interaction.  Occassional
trouble
remembering details of medical history
Orientation: Oriented to person, place, and date.
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, 5 to 3
mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice, finger rub.
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 [**4-20**] throughout. No pronator drift

Sensation: Intact to light touch.

Reflexes: B T Br Pa Ac
Right     2 2 2  2  2
Left      2 2 2  2  2

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, rapid alternating
movements, heel to shin


Pertinent Results:
MRI Head [**2145-6-24**]:
FINDINGS: In the left frontal lobe (13:18) is a 3 x 2.3 cm
heterogeneously
enhancing mass which is broad base along the dura. There is
significant high
FLAIR signal around this mass extending throughout the frontal
lobe and into
the anterior aspect of the left parietal lobe. There is mass
effect from the
heterogeneously enhancing mass as well as the edema causing
approximately 6 mm of rightward shift of normally midline
structures, but no evidence for
subfalcine, transtentorial or uncal herniation. There are no
other enhancing
masses identified. The ventricles and sulci appear normal in
size and
configuration. Vascular flow voids appear unremarkable. There is
no evidence
for acute territorial infarction. The orbits appear intact.
Paranasal
sinuses, ethmoid, and mastoid air cells are clear. There is an
anomalous
venous drainage arising in the right parietal lobe (10:59) which
is unchanged
from prior examination. There is decreased T1 marrow signal.

IMPRESSION:
1. Dural based left frontal heterogeneously enhancing mass with
surrounding
edema causing minimal rightward shift of midline but no
herniation. Given
patient's history of melanoma this is concerning for a
metastatic lesion.
There are no other lesions concerning for metastatic disease
identified.
2. Low T1 signal in the bone marrow may represent marrow
hyperplasia
secondary to known malignancy or its treatment, unchanged.
3. Right parietal developmental venous anomaly, unchanged.

CT Head [**2145-6-25**]:
FINDINGS: Patient is status post left frontal meningioma
resection. Expected post-surgical changes including
pneumocephalus is identified. There is a moderate amount of
edema in the left frontal lobe causing adjacent mass effect.
There is no significant amount of postoperative intracranial
hemorrhage identified. Small amount of hyperdense material
layering along the surgical margin is identified and is
expected. There is a 2 mm rightward shift of normally midline
structures. The ventricles and sulci are unremarkable. There is
no evidence of hydrocephalus.

IMPRESSION:
1. The patient is status post left frontal meningioma.
2. Expected post-surgical changes with pneumocephalus and
moderate amount of left frontal lobe edema causing mass effect
and minimal rightward shift of normally midline structures. No
significant amount of post-surgical
intracranial hemorrhage.

MRI Head [**2145-6-26**]:
FINDINGS: Since the previous MRI, the patient has undergone
resection of left frontal dural-based mass which are suspicious
for metastatic lesion. Blood products are seen at the surgical
site with evidence of air and extensive left frontal lobe edema
as before. There is mild pachymeningeal enhancement seen
following gadolinium. Mild enhancement is also seen surrounding
the area of blood products which is suspicious for mild residual
enhancement. There is no hydrocephalus seen. No acute infarct
identified.

IMPRESSION: Status post resection of left frontal mass with
blood products
and air at the surgical site with mild residual enhancement
adjacent to the
blood products at the surgical bed. Pachymeningeal postoperative
enhancement is also seen. Surrounding edema is identified.



Brief Hospital Course:
The patient was admitted to the ICU for Q 1 hour neuro checks
due to a large new brain mass with significant edema. She was
taken to the OR for a craniotomy for tumor resection later that
day. The procedure went well and the patient went back to the
ICU post-op. Her pain was well-controlled and she was
neurologically stable. Therefore, she was transferred to the
neurosurgery floor on [**2145-6-26**]. The patient was voiding on her
own and able to take in food without difficulty. She was seen by
physical therapy who felt since she was ambulating without
difficulty she did not need to be seen. On discharge her
incision was clean and dry, her exam was neurologically intact,
she was voiding without difficulty.

Medications on Admission:
none

Discharge Medications:
1. Outpatient Lab Work
Please obtain a dilantin level in one week. Have the results
faxed to to [**Telephone/Fax (1) 87**].
2. Phenytoin 50 mg Tablet, Chewable Sig: Two (2) Tablet,
Chewable PO TID (3 times a day).
Disp:*180 Tablet, Chewable(s)* Refills:*0*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
5. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO q8h () for 1
days.
Disp:*3 Tablet(s)* Refills:*0*
6. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO bid () for 1
days.
Disp:*2 Tablet(s)* Refills:*0*
7. Dexamethasone 1.5 mg Tablet Sig: Two (2) Tablet PO bid () for
1 days.
Disp:*4 Tablet(s)* Refills:*0*
8. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO bid ().
Disp:*60 Tablet(s)* Refills:*0*
9. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
brain mass


Discharge Condition:
neurologically stable


Discharge 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 and/or staples 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.
-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**].
-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 for suture/staple removal in [**6-25**] days from the date
of your surgery and a wound check. Please call [**Telephone/Fax (1) 1669**] to
schedule this appointment.

You should follow-up with Dr. [**Last Name (STitle) 724**] in the Brain [**Hospital 341**] clinic in
about 2 weeks. Call [**Telephone/Fax (1) 1844**] to schedule this appointment.
You do not need an MRI as this was done as an inpatient.

The following appointments were already made and are here as a
reminder to you.
Provider: [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]/CUT. ONC. DERM Date/Time:[**2145-7-21**]
10:30
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 19848**] CUTANEOUS ONCOLOGY Date/Time:[**2145-7-21**]
10:45
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 19848**] CUTANEOUS ONCOLOGY Date/Time:[**2145-7-21**]
11:15



Completed by:[**2145-6-28**]
{'Secondary malignant neoplasm of brain and spinal cord,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Personal history of malignant melanoma of skin,Personal history of irradiation, presenting hazards to health'}


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, confusion

PRESENT ILLNESS: 40 yo female with hx metastatic melanoma (dx [**2136**]) with
multiple recurrences (LNs, lungs, bowel) complains of 1 week of
dull headaches with a few days of confusion and difficulty
concentrating. Denies nausea/vomiting, seizures, weakness,
numbness, paresthesias, problems with vision or balance.

MEDICAL HISTORY: Melanoma course began in [**2136**], mole on back excised.  Recurrence
in R groin, treated with radiation, recurrence in lung, treated
with IL-2, recurrence in colon, partial colectomy. Currently has
nodes in R clavicle and abdomen.

MEDICATION ON ADMISSION: none

ALLERGIES: Naprosyn / Iodine / Adhesive Tape

PHYSICAL EXAM: Upon admission:
Gen: WD/WN, comfortable, NAD, obese.
HEENT: Pupils:   PERRLA      EOMs full
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect, somewhat tearful during interaction.  Occassional
trouble
remembering details of medical history
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: No smoking
Denies alcohol or drugs 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Personal history of malignant melanoma of skin,Personal history of irradiation, presenting hazards to health'}
