CHIEF COMPLAINT: suboccipital pseudomeningocele

PRESENT ILLNESS: This is a 30 yearr old gentleman who underwent a suboccipital
craniotomy and C1 laminectomy for Chiari decompression on
[**2130-3-30**]. He did well initally. On [**2130-4-30**] he presented to an OSH
complaining of occipital pressure.  Head CT at that time
revealed a pseudomeningocele and he was transferred to [**Hospital1 **]. On
[**2130-5-2**], he underwent a fluoroscopic-guided lumbar drainage
placement, the drain was ultimately removed and patient
discharged home on [**2130-5-5**].  On [**5-8**] patient complained of
posterior cervical headaches and was admitted to [**Hospital1 18**]
CT head showed progression of his pseudo meningocele. Lumbar
drain placement was attempted without success.

MEDICAL HISTORY: Asthma, Genital Herpes, Eczema, ADHD, allergic rhinitis,
anxiety, asthma, LB, prediabetes, PTSD

MEDICATION ON ADMISSION: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB or wheeze
2. Clobetasol Propionate 0.05% Ointment 1 Appl TP EVERY OTHER
DAY
to hands every other day
3. Epinephrine 1:1000 0.3 mg IM ONCE:PRN allergic reaction
in case of severe allergic reaction
4. Fluticasone Propionate NASAL 1 SPRY NU DAILY
5. Fluticasone-Salmeterol Diskus (500/50)  1 INH IH [**Hospital1 **]
6. Albuterol-Ipratropium 2 PUFF IH Q4H:PRN SOB or wheeze
7. Ranitidine 150 mg PO BID
8. ValACYclovir 500 mg PO Q24H
9. Cetirizine *NF* 10 mg Oral daily
10. Sodium Chloride Nasal [**11-28**] SPRY NU QID:PRN nasal congestion

ALLERGIES: Cephalexin / Penicillins / morphine / Albay Honey Bee Venom

PHYSICAL EXAM: On Admission
Gen: WD/WN, comfortable, NAD.
HEENT: Pronounced fluid collection occipital area,
 Pupils: [**1-27**] bilat EOMs bilat
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: NC

SOCIAL HISTORY: He is a truck driver. He has two children. He has smokes [**11-28**] ppd
since age 8. He denies ETOH use.
Central nervous system complication,Compression of brain,Candidiasis of mouth,Disorders of meninges, not elsewhere classified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, unspecified,Genital herpes, unspecified,Attention deficit disorder with hyperactivity,Contact dermatitis and other eczema, unspecified cause,Anxiety state, unspecified,Posttraumatic stress disorder,Tobacco use disorder,Other abnormal glucose
Surg complication - cns,Compression of brain,Thrush,Disorder of meninges NEC,Abn react-surg proc NEC,Asthma NOS,Genital herpes NOS,Attn deficit w hyperact,Dermatitis NOS,Anxiety state NOS,Posttraumatic stress dis,Tobacco use disorder,Abnormal glucose NEC
Admission Date:  [**2130-5-18**]              Discharge Date:   [**2130-5-30**]

Date of Birth:  [**2100-4-7**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Cephalexin / Penicillins / morphine / Albay Honey Bee Venom

Attending:[**First Name3 (LF) 14802**]
Chief Complaint:
suboccipital pseudomeningocele

Major Surgical or Invasive Procedure:
[**2130-5-18**] Suboccipital wond exploration and repair for CSF leak
[**2130-5-24**] Lumbar drain placement x 2


History of Present Illness:
This is a 30 yearr old gentleman who underwent a suboccipital
craniotomy and C1 laminectomy for Chiari decompression on
[**2130-3-30**]. He did well initally. On [**2130-4-30**] he presented to an OSH
complaining of occipital pressure.  Head CT at that time
revealed a pseudomeningocele and he was transferred to [**Hospital1 **]. On
[**2130-5-2**], he underwent a fluoroscopic-guided lumbar drainage
placement, the drain was ultimately removed and patient
discharged home on [**2130-5-5**].  On [**5-8**] patient complained of
posterior cervical headaches and was admitted to [**Hospital1 18**]
CT head showed progression of his pseudo meningocele. Lumbar
drain placement was attempted without success.

He went to the clinic in follow up complaining of headache that
is
worse when he gets up from supine position and fluid collection
in occipital area.  His headache are worse in the am. He also
reported blurred vision with
coughing and tingling, pins and needle sensation in right hand.
He is also complains of nausea due to sensation of pressure in
his head, stiff neck. Patient also has tingling tips of toes on
left foot.

Past Medical History:
Asthma, Genital Herpes, Eczema, ADHD, allergic rhinitis,
anxiety, asthma, LB, prediabetes, PTSD


Social History:
He is a truck driver. He has two children. He has smokes [**11-28**] ppd
since age 8. He denies ETOH use.


Family History:
NC

Physical Exam:
On Admission
Gen: WD/WN, comfortable, NAD.
HEENT: Pronounced fluid collection occipital area,
 Pupils: [**1-27**] bilat EOMs bilat
Extrem: Warm and well-perfused. No C/C/E.

Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
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, to
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 finger rub bilaterally.
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 [**4-1**] throughout. No pronator drift

Sensation: Intact to light touch

Coordination: normal on finger-nose-finger

Upon discharge:
Awake, alert, oriented, demonstrates competency, MAE full motor,
surgical site is C/D/I and flat.

Pertinent Results:
MRI Lspine [**2130-5-22**]:
IMPRESSION:
1.  Abnormal low signal in the thecal sac from L1 through L4 is
most likely
due to subarachnoid hemorrhage from the recent instrumentation.
Very less
likely, this could represent an intradural mass.  Recommend
followup with the
repeat lumbar MRI to ensure resolution of the blood products.
2.  Increased prominence of the anterior epidural space is
likely due to a
small amount of post-procedural hemorrhage or CSF leak.
3.  Stable degenerative changes in comparison to [**2127**], with a
disc protrusion
at L4-5.


Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the Neurosurgery service after
surgical wound exploration of a subocciptal pseudomeningocele
with dural repair.  Please see Operative Reports for full
details.  A Hemovac drain was placed intraoperatively.
Post-operatively, he was taken to the SICU for close monitoring.
 He was able to tolerate a regular diet starting the evening
after surgery and was noted to be neurologically intact.  A
Foley catheter was placed prior to surgery. He was given
prophylactic Vancomycin in light of his allergy to Cephalexin
and Penicillins.

On [**5-19**], patient doing well, hemovac had an output of 100cc and
was left in place. He was encouraged to mobilize and HOB at 90
degrees at all times. He was transferred to the SDU in stable
condition. On [**5-20**] he reported burning dysesthetic pain and
Neurontin was started. He remained stable on [**5-21**] and on [**5-22**] he
was noted to have increased drainage from his hemovac and it was
determined that a lumbar drain would be required and IR was
contact[**Name (NI) **] to perform it. Given the difficulty of prior lumbar
drain placements in this patient an MRI L-Spine was first
obtained.  IR declined to place lumbar drain.  On [**5-23**], a lumbar
puncture for large volume tap was attempted and unsuccessful.
As such, patient was scheduled to undergo operative drain
placement on [**5-24**].

The patient had two lumbar drains (epidural catheters) placed
successfully on [**5-24**] under concious sedation in the OR.  The
procedure was uncomplicated.  Drain output was initiated at
15-20 mL/hr with a plan for 7 days of drainage  from the Lumbar
Drain.

On [**5-26**], acyclovir prophylaxis was discontinued.  The patient
remained stable.  On [**5-27**], the patient's hemovac fell out.  2
staples were placed over the hemovac site.  The patient remained
stable through out his hospital stay.

On [**5-30**] he expressed he wanted to discontinue the plan of care
and leave against medical advice. He stated he wanted the team
to remove the drains or he would. Dr [**Last Name (STitle) **] discussed the
risks of discontinueing his current plan. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 83809**] and [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] also discussed this with him. A meeting was held with
his wife - [**Name (NI) **] [**Name (NI) 83809**], [**First Name4 (NamePattern1) **] [**Name (NI) **], [**First Name4 (NamePattern1) 2808**] [**Last Name (NamePattern1) 21991**], and
[**Doctor First Name 1258**] from Case Management were in attendance. We discussed
his plan of care and discharge needs. Upon removal of his drains
he refused any closure to be done to close the lumbar drain
sites. The risks of this was explained to him by multiple
midlevels on the team and he allowed us to place 2 staples. The
patient then stated he would remove his staples/sutures
independently, he was advised against this, and the option of
follow-up on Thursday for removal was given which he declined,
Monday was agreed upon.


Medications on Admission:
1. Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB or wheeze
2. Clobetasol Propionate 0.05% Ointment 1 Appl TP EVERY OTHER
DAY
to hands every other day
3. Epinephrine 1:1000 0.3 mg IM ONCE:PRN allergic reaction
in case of severe allergic reaction
4. Fluticasone Propionate NASAL 1 SPRY NU DAILY
5. Fluticasone-Salmeterol Diskus (500/50)  1 INH IH [**Hospital1 **]
6. Albuterol-Ipratropium 2 PUFF IH Q4H:PRN SOB or wheeze
7. Ranitidine 150 mg PO BID
8. ValACYclovir 500 mg PO Q24H
9. Cetirizine *NF* 10 mg Oral daily
10. Sodium Chloride Nasal [**11-28**] SPRY NU QID:PRN nasal congestion


Discharge Medications:
1. Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB or wheeze
2. Cetirizine *NF* 10 mg Oral daily
3. Fluticasone Propionate NASAL 1 SPRY NU DAILY
4. Fluticasone-Salmeterol Diskus (500/50)  1 INH IH [**Hospital1 **]
5. Clobetasol Propionate 0.05% Ointment 1 Appl TP EVERY OTHER
DAY
to hands every other day
6. Docusate Sodium 100 mg PO BID
RX *Colace 100 mg 1 Capsule(s) by mouth twice a day Disp #*90
Capsule Refills:*0
7. Gabapentin 300 mg PO TID
RX *gabapentin 300 mg 1 Capsule(s) by mouth three times a day
Disp #*90 Capsule Refills:*0
8. HYDROmorphone (Dilaudid) 2-4 mg PO Q6H:PRN pain
RX *Dilaudid 2 mg [**11-28**] Tablet(s) by mouth every six (6) hours
Disp #*30 Tablet Refills:*0
9. Nystatin Oral Suspension 5 mL PO PRN thrush
swish and swallow
RX *nystatin 100,000 unit/mL 5 mL by mouth Oral thrush Disp #*1
Bottle Refills:*0
10. Acetaminophen 325-650 mg PO Q6H:PRN Pain or fever
11. Mupirocin Cream 2% 1 Appl TP [**Hospital1 **]
RX *Bactroban 2 % Apply to the affected areas twice a day Disp
#*1 Tube Refills:*0
12. Ranitidine 150 mg PO BID


Discharge Disposition:
Home

Discharge Diagnosis:
Psuedomeningocele


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


Discharge Instructions:
Dear Mr [**Known lastname **],

You were admitted to Dr[**Name (NI) 83810**] service with
pseudomeninogcele and underwent a suboccipital craniotomy for
exploration and repair of a CSF leak. A surgical drain was left
in place to help reduce pooling of CSF at the surgical site so
healing could be optimal. Two lumbar drains were also placed to
promote healing. You removed your wound drain on [**5-27**]. The plan
was to maintain the two lumbar drains for a total of 7 days
([**6-1**]) and then remove or clamp the drains and monitor for
leaking. On [**5-30**], you expressed desire to go home and not
continue the current plan of care. Dr [**Last Name (STitle) **] spoke with you at
length regarding the risks of leaving before we can ensure that
proper healing was achieved. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 83809**] and [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] also
met with you and discussed the risks of discontinueing the
current plan of care. We also explained to you that you leaving
would be against medical advice. Your lumbar drains were removed
and two staples were placed.

General 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. Weight limitation of 10lbs.
??????	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.
??????	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 Appointment Instructions

* Please call [**Telephone/Fax (1) 2731**] to make an appointment for a wound
check and staple removal. We would like to see you on Monday,
[**6-5**]. Further follow-up can be made at that time.

* Please call [**Telephone/Fax (1) 2731**] with any questions or concerns. On
off hours, please call [**Telephone/Fax (1) 70484**] and ask for the neurosurgery
oncall pager to be paged.



Completed by:[**2130-5-30**]
{'Central nervous system complication,Compression of brain,Candidiasis of mouth,Disorders of meninges, not elsewhere classified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, unspecified,Genital herpes, unspecified,Attention deficit disorder with hyperactivity,Contact dermatitis and other eczema, unspecified cause,Anxiety state, unspecified,Posttraumatic stress disorder,Tobacco use disorder,Other abnormal glucose'}


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: suboccipital pseudomeningocele

PRESENT ILLNESS: This is a 30 yearr old gentleman who underwent a suboccipital
craniotomy and C1 laminectomy for Chiari decompression on
[**2130-3-30**]. He did well initally. On [**2130-4-30**] he presented to an OSH
complaining of occipital pressure.  Head CT at that time
revealed a pseudomeningocele and he was transferred to [**Hospital1 **]. On
[**2130-5-2**], he underwent a fluoroscopic-guided lumbar drainage
placement, the drain was ultimately removed and patient
discharged home on [**2130-5-5**].  On [**5-8**] patient complained of
posterior cervical headaches and was admitted to [**Hospital1 18**]
CT head showed progression of his pseudo meningocele. Lumbar
drain placement was attempted without success.

MEDICAL HISTORY: Asthma, Genital Herpes, Eczema, ADHD, allergic rhinitis,
anxiety, asthma, LB, prediabetes, PTSD

MEDICATION ON ADMISSION: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB or wheeze
2. Clobetasol Propionate 0.05% Ointment 1 Appl TP EVERY OTHER
DAY
to hands every other day
3. Epinephrine 1:1000 0.3 mg IM ONCE:PRN allergic reaction
in case of severe allergic reaction
4. Fluticasone Propionate NASAL 1 SPRY NU DAILY
5. Fluticasone-Salmeterol Diskus (500/50)  1 INH IH [**Hospital1 **]
6. Albuterol-Ipratropium 2 PUFF IH Q4H:PRN SOB or wheeze
7. Ranitidine 150 mg PO BID
8. ValACYclovir 500 mg PO Q24H
9. Cetirizine *NF* 10 mg Oral daily
10. Sodium Chloride Nasal [**11-28**] SPRY NU QID:PRN nasal congestion

ALLERGIES: Cephalexin / Penicillins / morphine / Albay Honey Bee Venom

PHYSICAL EXAM: On Admission
Gen: WD/WN, comfortable, NAD.
HEENT: Pronounced fluid collection occipital area,
 Pupils: [**1-27**] bilat EOMs bilat
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: NC

SOCIAL HISTORY: He is a truck driver. He has two children. He has smokes [**11-28**] ppd
since age 8. He denies ETOH use. 

### Response:
{'Central nervous system complication,Compression of brain,Candidiasis of mouth,Disorders of meninges, not elsewhere classified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, unspecified,Genital herpes, unspecified,Attention deficit disorder with hyperactivity,Contact dermatitis and other eczema, unspecified cause,Anxiety state, unspecified,Posttraumatic stress disorder,Tobacco use disorder,Other abnormal glucose'}
