CHIEF COMPLAINT: Seizure

PRESENT ILLNESS: 59 RHM with hypothyroidism and asthma presents following a
seizure and minor motor vehicle accident and found to have right
temporal mass on CT and neurosurgery consulted regarding
management.

MEDICAL HISTORY: Asthma
Hypothyroidism

MEDICATION ON ADMISSION: Advair
Levothyroxine

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission
T: ND BP: 141/92 HR:68 R 12 O2Sats 96% RA
Gen: Commfortable. Slightly disoriented. Drowsy and at [**Name (NI) 91588**]
times
will keep eyes closed and continue conversation.
2x small lacs left antero/lateral tongue
HEENT: Pupils: PERRLA EOMs upgzae nystagmus
Neck: Supple. No carotid bruits. NO neck injries.
Lungs: CTA bilaterally.
Cardiac: RRR. Normal S1/S2 without murmurs. JVP not elevated.
Abd: Soft, NT, BS+. No obviosu masses.
Extrem: Warm and well-perfused. Calves SNT. Good peripheral
pulses. NO spinal tenderness.

FAMILY HISTORY: Mother - colon ca
[**Name (NI) 91589**] - nil of note
Sister [**Name (NI) 17095**]

SOCIAL HISTORY: Lives with wife
[**Name (NI) 1403**] as a biologist for Mas Dep of Conservation and Recreation
on water supply
Independently mobile
Never smoked
Drinks [**12-22**] glasses of wine or beer per night. Can miss [**First Name (Titles) 91588**]
[**Last Name (Titles) **].
No illicits
Malignant neoplasm of temporal lobe,Cerebral edema,Other convulsions,Asthma, unspecified type, unspecified,Unspecified acquired hypothyroidism,Family history of malignant neoplasm of gastrointestinal tract
Mal neo temporal lobe,Cerebral edema,Convulsions NEC,Asthma NOS,Hypothyroidism NOS,Family hx-gi malignancy
Name:  [**Known lastname 14423**],[**Known firstname 77**]                    Unit No:   [**Numeric Identifier 14424**]

Admission Date:  [**2138-10-12**]              Discharge Date:   [**2138-10-17**]

Date of Birth:  [**2079-9-9**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 599**]
Addendum:
Brain [**Hospital 26**] clinic is scheduled for [**10-27**] at 10:30.

Discharge Disposition:
Home

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 603**] MD [**MD Number(2) 604**]

Completed by:[**2138-10-17**]

Admission Date:  [**2138-10-12**]              Discharge Date:   [**2138-10-17**]

Date of Birth:  [**2079-9-9**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
[**2138-10-15**] Right craniotomy temporal lobectomy and resection of
mass


History of Present Illness:
59 RHM with hypothyroidism and asthma presents following a
seizure and minor motor vehicle accident and found to have right
temporal mass on CT and neurosurgery consulted regarding
management.

Patient was drowsy on assessment and at times would close his
eyes but still continue conversation. Patient has been in his
usual state of health on [**2138-10-11**] and indeed went for a 3 mile
run. At around 2pm, he was taking shopping back from CostCo when
he [**Location 91587**] and per report drove across empty lanes
across the road and came to rest at a mailbox and latterly
before
a stone wall. Patient was not travelling at high speed, air bag
was not deployed and patient had no injuries from this. Car was
minimally damanged and wife was able to drive home. he next
thing
he remenbres was waking up in [**Hospital3 417**] Hospital. He had
not
been incontinent of urine but had bitten his tongue. It was
unclear whether he had convuslions at the time. He was
post-ictal
with drowsiness and confusion post seizure. CT there showed
right
temporal hypodensity with edema and minimal midline shift. He
was
given IV keppra 500mg and Dexamethasone 10mg IV and lorazepam
1mg
IV x2. He was transferred for neurosurgical assessment.

On assessment, patient is verbalising well but repeatedly
blinking and at times closing eyes.


Past Medical History:
Asthma
Hypothyroidism

Social History:
Lives with wife
[**Name (NI) 1403**] as a biologist for Mas Dep of Conservation and Recreation
on water supply
Independently mobile
Never smoked
Drinks [**12-22**] glasses of wine or beer per night. Can miss [**First Name (Titles) 91588**]
[**Last Name (Titles) **].
No illicits


Family History:
Mother - colon ca
[**Name (NI) 91589**] - nil of note
Sister [**Name (NI) 17095**]


Physical Exam:
On Admission
T: ND BP: 141/92 HR:68 R 12 O2Sats 96% RA
Gen: Commfortable. Slightly disoriented. Drowsy and at [**Name (NI) 91588**]
times
will keep eyes closed and continue conversation.
2x small lacs left antero/lateral tongue
HEENT: Pupils: PERRLA EOMs upgzae nystagmus
Neck: Supple. No carotid bruits. NO neck injries.
Lungs: CTA bilaterally.
Cardiac: RRR. Normal S1/S2 without murmurs. JVP not elevated.
Abd: Soft, NT, BS+. No obviosu masses.
Extrem: Warm and well-perfused. Calves SNT. Good peripheral
pulses. NO spinal tenderness.

Neuro:
Mental status: Drowsy, cooperative with exam, normal affect.
Orientation: Oriented to person, place, and partially date
thought was [**2138-11-11**].
Good attention did [**Doctor Last Name 1841**] backwards.
Recall: [**12-23**] objects at 5 minutes [**2-20**] w prompting.
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
bilaterally.
Fundi revealed no papilledema.
III, IV, VI: Bilateral upgaze nystagmus.
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.

Limb exam:

Normal tone throughout.
Motor:Full power throughout
Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally save slight decreased vibration at left
great toe.

Reflexes: B T Br Pa Ac
Right     2 2 2  2  2
Left      2 2 2  2  2
Plantar reflexes extensor on left and equivocal on right.

Cerebellar: L intention tremor. No gross finger/nose ataxia. No
heel-shin ataxia.


Pertinent Results:
[**2138-10-12**] MRI brain with and without contrast:
IMPRESSION:
A heterogeneous lesion in the right temporal lobe measuring
approximately
5.3 x 3.0 cm with heterogeneous nodular peripheral enhancement,
moderate
surrounding vasogenic edema and mass effect on the right lateral
ventricle. Possibilities include a primary neoplasm such as a
glial tumor-GBM or a metastatic lesion; less likely lymphoma,
etc.

[**2138-10-12**]: CT chest/Abd/Pelvis:
IMPRESSION:
1. No evidence of primary malignancy within the chest or
abdomen.
2. Tiny low-density lesion within the pancreatic head is not
concerning for pancreatic adenocarcinoma; it may represent a
cystic lesion or interdigitating fat. An MRCP is recommended on
a non-urgent basis within 6 months to evaluate for an incidental
cystic pancreatic lesion.
3. Small Bochdalek hernia.

[**10-13**]: Functional MRI and MR Spect
Successful functional MRI of the brain, demonstrating the
expected activation areas in the cerebral cortex during the
movement of the hands, feet, language, and during the movement
of the tongue. No significant activation areas are adjacent to
the right temporal mass lesion, which is unchanged since the
most recent study. The ASL sequence demonstrates no significant
perfusion. The spectroscopy indicates elevated ratio for Choline
medially, suggesting malignancy, either primary or metastatic.

[**10-15**]: MRI IMPRESSION: Relatively stable and unchanged right
temporal intra-axial mass lesion with ring-enhancing pattern and
necrosis and also associated vasogenic edema, causing mild
effacement of the right perimesencephalic cistern as described
above. No new lesions are identified in the interval.

[**10-15**] CT Head- IMPRESSION: Immediately status post right
temproparietal craniotomy, with post-surgical changes but no
evidence of acute complication.

[**10-16**] MRI Brain- Post op changes, enhancement along surgical bed
consistent with surgical changes.  No acute infarct or
hemorrhage.

Brief Hospital Course:
Mr [**Known lastname 78697**] was admitted to the Neurosurgery service for workup of
right temporal brain lesion.  He was started on Keppra 500mg [**Hospital1 **]
for seizure prophylaxis and dexamethasone for cerebral edema.
He underwent MRI brain to better evaluate the lesion.  CT of the
chest, abdomen and pelvis was performed to rule out primary
malignancy.  Neuro- oncology and radiation oncology were
consulted.  After discussion with patient and wife the decision
was made to plan for craniotomy for resection of the lesion.

On [**2138-10-13**] he underwent functional MRI testing that
demonstrated the expected activation areas in the cerebral
cortex during the movement of the hands, feet, language, and
during the movement of the tongue. No significant activation
areas are adjacent to the right temporal mass lesion.
On [**10-15**] He went to the OR and underwent a craniotomy and
temporal lobectomy for resection of tumor. Surgery was without
complication. He was extubated and transferred to the ICU for
close neuro observation. Post op head CT revealed post operative
changes and no hemorrhage.
On [**10-16**] he was neurologically well. He was cleared for transfer
to the floor, foley was discontinued and activity/diet were
advanced.
Now DOD, pt is afebrile, VSS, and neurologically intact.  His
incision is clean/dry and intact.  He is ambulating without
issues and tolerating a good oral diet.  He is set for discharge
home in stable.

Medications on Admission:
Advair
Levothyroxine

Discharge Medications:
1. fluticasone-salmeterol 100-50 mcg/dose Disk with Device Sig:
One (1) puff Inhalation [**Hospital1 **] (2 times a day).
2. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for Pain.
Disp:*60 Tablet(s)* Refills:*0*
4. butalbital-acetaminophen-caff 50-325-40 mg Tablet Sig: One
(1) Tablet PO Q4H (every 4 hours) as needed for pain.
Disp:*80 Tablet(s)* Refills:*0*
5. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*2*
6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
7. cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 6 days.
Disp:*24 Capsule(s)* Refills:*0*
8. dexamethasone 2 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
right temporal mass
seizure

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


Discharge Instructions:
General Instructions/Information

??????	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. If your wound closure uses dissolvable sutures,
you must keep that area dry for 10 days.
-       Keep wound clean and dry thereafter
??????	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.
??????	If you have been discharged on Keppra (Levetiracetam), you
will not require blood work monitoring.
??????	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.
??????	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.
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: increasing redness,
increased swelling, increased tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please return to the office in [**6-29**] days (from your date of
surgery) for removal of your staples/sutures and/or a wound
check. This appointment can be made with the Nurse Practitioner.
 Please make this appointment by calling [**Telephone/Fax (1) 1669**]. If you
live quite a distance from our office, please make arrangements
for the same, with your PCP.
??????Brain [**Hospital 341**] clinic will contact you about your Brain [**Hospital 341**]
Clinic appointment.   If you have question or you have not been
contact[**Name (NI) **] please call them at the phone number below. 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) **]. Their phone number is [**Telephone/Fax (1) 1844**].
Please call if you need to change your appointment, or require
additional directions.
??????You will need an MRI of the brain with/without gadolinium
contrast.  If you are required to have a MRI, you may also
require a blood test to measure your BUN and Cr within 30 days
of your MRI.  This can be measured by your PCP, [**Name10 (NameIs) **] please
make sure to have these results with you, when you come in for
your appointment.



Completed by:[**2138-10-17**]
{'Malignant neoplasm of temporal lobe,Cerebral edema,Other convulsions,Asthma, unspecified type, unspecified,Unspecified acquired hypothyroidism,Family history of malignant neoplasm of gastrointestinal tract'}


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: Seizure

PRESENT ILLNESS: 59 RHM with hypothyroidism and asthma presents following a
seizure and minor motor vehicle accident and found to have right
temporal mass on CT and neurosurgery consulted regarding
management.

MEDICAL HISTORY: Asthma
Hypothyroidism

MEDICATION ON ADMISSION: Advair
Levothyroxine

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission
T: ND BP: 141/92 HR:68 R 12 O2Sats 96% RA
Gen: Commfortable. Slightly disoriented. Drowsy and at [**Name (NI) 91588**]
times
will keep eyes closed and continue conversation.
2x small lacs left antero/lateral tongue
HEENT: Pupils: PERRLA EOMs upgzae nystagmus
Neck: Supple. No carotid bruits. NO neck injries.
Lungs: CTA bilaterally.
Cardiac: RRR. Normal S1/S2 without murmurs. JVP not elevated.
Abd: Soft, NT, BS+. No obviosu masses.
Extrem: Warm and well-perfused. Calves SNT. Good peripheral
pulses. NO spinal tenderness.

FAMILY HISTORY: Mother - colon ca
[**Name (NI) 91589**] - nil of note
Sister [**Name (NI) 17095**]

SOCIAL HISTORY: Lives with wife
[**Name (NI) 1403**] as a biologist for Mas Dep of Conservation and Recreation
on water supply
Independently mobile
Never smoked
Drinks [**12-22**] glasses of wine or beer per night. Can miss [**First Name (Titles) 91588**]
[**Last Name (Titles) **].
No illicits 

### Response:
{'Malignant neoplasm of temporal lobe,Cerebral edema,Other convulsions,Asthma, unspecified type, unspecified,Unspecified acquired hypothyroidism,Family history of malignant neoplasm of gastrointestinal tract'}
