CHIEF COMPLAINT: dizziness

PRESENT ILLNESS: 70 y/o M with no significant past medical history presents
today to OSH after falls and dizziness for a week and a half. He
states that he has been having difficulties with balance and
grasping objects with his left hand. He also reports listing to
the L when ambulating and headache [**8-31**] in the R frontal
region.
It was noticed by his boss that his L pupil was larger than his
right. He denies any n/v, visual changes, or numbness and
tingling. He was transferred to [**Hospital1 18**] after head CT showed a R
occipital mass. Neurosurgery was consulted for further
evaluation.

MEDICAL HISTORY: seizures s/p MVA when he was 27, has not had seizures in
>30yrs. Wife states that he had only two seizures.

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-22**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: father passed away from leukemia

SOCIAL HISTORY: Lives with wife at home, + tobacco 1ppd x 55yrs. -ETOH
Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of lymph nodes of multiple sites,Peripheral autonomic neuropathy in disorders classified elsewhere,Hallucinogen abuse, continuous
Sec mal neo brain/spine,Cerebral edema,Mal neo upper lobe lung,Mal neo lymph node-mult,Aut neuropthy in oth dis,Hallucinog abuse-contin
Admission Date:  [**2160-12-31**]              Discharge Date:   [**2161-1-5**]

Date of Birth:  [**2090-12-26**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
dizziness

Major Surgical or Invasive Procedure:
[**2161-1-2**] craniotomy for tumor resection


History of Present Illness:
70 y/o M with no significant past medical history presents
today to OSH after falls and dizziness for a week and a half. He
states that he has been having difficulties with balance and
grasping objects with his left hand. He also reports listing to
the L when ambulating and headache [**8-31**] in the R frontal
region.
It was noticed by his boss that his L pupil was larger than his
right. He denies any n/v, visual changes, or numbness and
tingling. He was transferred to [**Hospital1 18**] after head CT showed a R
occipital mass. Neurosurgery was consulted for further
evaluation.


Past Medical History:
seizures s/p MVA when he was 27, has not had seizures in
>30yrs. Wife states that he had only two seizures.


Social History:
Lives with wife at home, + tobacco 1ppd x 55yrs. -ETOH


Family History:
father passed away from leukemia


Physical Exam:
On admission:
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-22**] objects at 5 minutes.
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, L 5-4mm, R
3-2mm.
L peripheral visual field cut.
III, IV, VI: Extraocular movements intact bilaterally without
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.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors.

Motor: D B T IP  [**Initials (NamePattern5) 89627**] [**Last Name (NamePattern5) **] AT [**Last Name (un) 938**]
     R 5 5 5  5  5  5  5    5  5
     L 4 5 5  5- 5- 5- 5-   5- 5-

Sensation: Intact to light touch, proprioception, pinprick and
vibration bilaterally.

Toes downgoing bilaterally

Coordination: L dysmetria, rapid alternating
movements, heel to shin intact

On discharge:
AOx3, R horner's syndrome, dysmetria improved and no longer
noted. BUE are full and BLE are full.


Pertinent Results:
CT Torso [**2161-1-1**]:
IMPRESSION:
1. Spiculated right upper lobe lesion measuring up to 1.3 cm.
2. Multiple enlarged and necrotic lymph nodes throughout the
chest, abdomen,
and pelvis. The largest of these, a right supraclavicular
conglomerate is
amenable to ultrasound-guided biopsy.
3. Small left-sided hydrocele. Right scrotal fluid collection
appears to
displace the testicle and may represent a spermatocele. Scrotal
ultrasound
recommended.

MRI Brain [**2161-1-2**]:
There are multiple rim-enhancing masses scattered throughout the
brain, most compatible with metastatic disease. For example, a
rim-enhancing mass is demonstrated within the left cerebellar
hemisphere, the
bilateral frontal lobes and the left parietal lobe (series 2:
image 78). The dominant mass is demonstrated within the right
parieto-occipital region (series 2: image 53) measuring 3.9 x
3.5 x 3.9 cm in the AP x TRV x SI dimensions. There is a smaller
satellite nodule demonstrated immediately adjacent to the
dominant mass. The dominant mass demonstrates heterogeneous
enhancement with a low T1 signal intensity central component
most compatible with necrosis. There is associated extensive
edema surrounding this lesion. There is no significant mass
effect by these multiple lesions with no shift of the normally
midline structures. There is no evidence of transtentorial or
uncal herniation. The
ventricles and sulci are normal in size and configuration. There
is no
evidence of hemorrhage. There is no gross bony metastasis. The
left
maxillary sinus is hypoplastic.

IMPRESSION: Multiple rim-enhancing masses scattered throughout
both the
supratentorial and infratentorial brain with features most
compatible with
metastasis. The dominant lesion is detailed as above located
within the right parieto-occipital region with associated
surrounding edema.

MRI Brain [**2161-1-3**]:
Status post resection of right occipital mass with blood
products and
postoperative changes in the region without acute infarct. Small
area of
residual enhancement is seen at the lateral aspect of the blood
products from surgery. Other enhancing smaller brain masses are
again identified, unchanged from previous MRI of [**2161-1-2**]. No
acute infarcts or midline shift seen.


Brief Hospital Course:
70M who presented to the ER with dizziness, a Head CT revealed a
R occipital mass with extensive vasogenic edema. Decadron was
started on admission. A CT Torso was obtained which revealed a
RUL chest mass. Oncology, Neuro-oncology, and Radiation-oncology
were consulted. A WAND MRI study was obtained which revealed
multiple brain lesions. He was taken to the OR on [**2161-1-2**] for
tumor resection. Post-operatively, he remained in the Neuro ICU
for observation. His exam remained stable and he was transferred
to the floor on [**2161-1-3**]. A post-operative MRI was obtained
which was stable. He was discharged home on [**2161-1-5**].

Medications on Admission:
None

Discharge Medications:
1. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. phenytoin sodium extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
Disp:*90 Capsule(s)* Refills:*2*
5. nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
6. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
7. acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
8. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): Please continue while on steroids.
Disp:*60 Tablet(s)* Refills:*2*
9. dexamethasone 1 mg Tablet Sig: Three (3) Tablet PO every
eight (8) hours for 4 days.
Disp:*36 Tablet(s)* Refills:*0*
10. dexamethasone 2 mg Tablet Sig: One (1) Tablet PO every eight
(8) hours: Start after 3mg dosing is done and continue at this
dose until follow-up.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
VNA of the [**Location (un) 1121**]

Discharge Diagnosis:
Multiple Brain Masses
Lung Mass


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.
??????	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 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**].
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.


Followup Instructions:
Please follow-up in the Brain [**Hospital 341**] Clinic on [**1-19**] at
3pm. You will meet with the Neuro-Oncolgolist,
Radiation-Oncologist, and Neurosurgery that day.

Please call the Thoracic [**Hospital **] Clinic at [**0-0-**] to make
an appointment.

Please call Dr. [**Last Name (STitle) **] office at [**Telephone/Fax (1) 4296**] to make an
appointment for staple removal 10 days from surgery.



Completed by:[**2161-1-5**]
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of lymph nodes of multiple sites,Peripheral autonomic neuropathy in disorders classified elsewhere,Hallucinogen abuse, continuous'}


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: dizziness

PRESENT ILLNESS: 70 y/o M with no significant past medical history presents
today to OSH after falls and dizziness for a week and a half. He
states that he has been having difficulties with balance and
grasping objects with his left hand. He also reports listing to
the L when ambulating and headache [**8-31**] in the R frontal
region.
It was noticed by his boss that his L pupil was larger than his
right. He denies any n/v, visual changes, or numbness and
tingling. He was transferred to [**Hospital1 18**] after head CT showed a R
occipital mass. Neurosurgery was consulted for further
evaluation.

MEDICAL HISTORY: seizures s/p MVA when he was 27, has not had seizures in
>30yrs. Wife states that he had only two seizures.

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-22**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: father passed away from leukemia

SOCIAL HISTORY: Lives with wife at home, + tobacco 1ppd x 55yrs. -ETOH 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of lymph nodes of multiple sites,Peripheral autonomic neuropathy in disorders classified elsewhere,Hallucinogen abuse, continuous'}
