CHIEF COMPLAINT: Right subdural collection

PRESENT ILLNESS: The patient is a 55-year-old male with a history of shunt and
revision in the past. About 2 to 3 months ago, the patient had a
shunt infection and the whole
shunt was removed by Dr. [**Last Name (STitle) **]. However, at that point, the
subdural collection was left intact. The patient was given
antibiotics for long-term. The patient followed up with me, and
he had a CAT scan as well as an MRI. Initially, the patient
refused the proposed surgery due to my suspicion that
this was representing an abscess. He continued with antibiotic
treatment. However, the patient started to deteriorate
neurologically, with difficulty with speech and also weakness of
the left side. An MRI showed enhancement of
that collection with what seemed to be a very thick membrane.
Then finally, the patient agreed to surgery.

MEDICAL HISTORY: -[**2109-12-13**] Cardiac Catheterization - LAD with proximal 40% and
mid
70% stenosis. Ramus with a large mid 90% stenosis was stented
with 2.5 x 23mm CYPHER DES and 3 x 13mm CYPHER DES with TIMI 3
flow. RCA was occluded in the mid segment and could not be
engaged but was filled with left-right callaterals.
-Bipolar
- NPH status post Right VP shunt in [**6-26**] and revision [**9-26**]
-Asthma
-ADHD
-High Cholesterol
-HTN
-PTSD
-AAA
- DJD
PSH: [**Name (NI) 10259**], PTCA, VP shunt [**6-26**] (Dr. [**First Name (STitle) **]/[**Hospital1 336**]), revision of VP
shunt [**9-26**] (Dr. [**Last Name (STitle) **]/[**Hospital1 18**])

MEDICATION ON ADMISSION: ASA 325, Darvan, flomax, lisinopril, metoprolol, proventil,
spiriva, prednisone, protonix, simvastatin, diasepam, neb

ALLERGIES: Levofloxacin / Codeine / Iodine; Iodine Containing / Oxycodone /
Hydrocodone

PHYSICAL EXAM: From post op check
99.1  75  15  132/74
Alert and oriented x 3
Mild dysarthria
Full with all 4 extremities
No pronator drift
Eyes open spontaneously
Incision C/D/I

FAMILY HISTORY: (+) [**Name (NI) 41900**] CAD Father has CAD and CHF. Social History: Married
for 15 years with two children 10 daughter and 14 son.

SOCIAL HISTORY: (+) cigarette smoking -quit in [**11-25**] 60ppy history, [**12-24**] ppd
on and off for 40 years
Infection and inflammatory reaction due to nervous system device, implant, and graft,Intracranial abscess,Other convulsions,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Bipolar disorder, unspecified,Chronic obstructive asthma, unspecified,Long-term (current) use of steroids,Abdominal aneurysm without mention of rupture,Posttraumatic stress disorder,Pure hypercholesterolemia,Unspecified essential hypertension,Attention deficit disorder with hyperactivity
React-nerv sys dev/graft,Intracranial abscess,Convulsions NEC,Retention urine NOS,Crnry athrscl natve vssl,Status-post ptca,Bipolar disorder NOS,Chronic obst asthma NOS,Long-term use steroids,Abdom aortic aneurysm,Posttraumatic stress dis,Pure hypercholesterolem,Hypertension NOS,Attn deficit w hyperact
Admission Date:  [**2111-11-6**]              Discharge Date:   [**2111-11-17**]

Date of Birth:  [**2056-2-3**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Levofloxacin / Codeine / Iodine; Iodine Containing / Oxycodone /
Hydrocodone

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
Right subdural collection

Major Surgical or Invasive Procedure:
Right craniotomy for evacuation of right subdural
abscess/empyema.


History of Present Illness:
The patient is a 55-year-old male with a history of shunt and
revision in the past. About 2 to 3 months ago, the patient had a
shunt infection and the whole
shunt was removed by Dr. [**Last Name (STitle) **]. However, at that point, the
subdural collection was left intact. The patient was given
antibiotics for long-term. The patient followed up with me, and
he had a CAT scan as well as an MRI. Initially, the patient
refused the proposed surgery due to my suspicion that
this was representing an abscess. He continued with antibiotic
treatment. However, the patient started to deteriorate
neurologically, with difficulty with speech and also weakness of
the left side. An MRI showed enhancement of
that collection with what seemed to be a very thick membrane.
Then finally, the patient agreed to surgery.

Past Medical History:
-[**2109-12-13**] Cardiac Catheterization - LAD with proximal 40% and
mid
70% stenosis. Ramus with a large mid 90% stenosis was stented
with 2.5 x 23mm CYPHER DES and 3 x 13mm CYPHER DES with TIMI 3
flow. RCA was occluded in the mid segment and could not be
engaged but was filled with left-right callaterals.
-Bipolar
- NPH status post Right VP shunt in [**6-26**] and revision [**9-26**]
-Asthma
-ADHD
-High Cholesterol
-HTN
-PTSD
-AAA
- DJD
PSH: [**Name (NI) 10259**], PTCA, VP shunt [**6-26**] (Dr. [**First Name (STitle) **]/[**Hospital1 336**]), revision of VP
shunt [**9-26**] (Dr. [**Last Name (STitle) **]/[**Hospital1 18**])


Social History:
(+) cigarette smoking -quit in [**11-25**] 60ppy history, [**12-24**] ppd
on and off for 40 years


Family History:
(+) [**Name (NI) 41900**] CAD Father has CAD and CHF. Social History: Married
for 15 years with two children 10 daughter and 14 son.


Physical Exam:
From post op check
99.1  75  15  132/74
Alert and oriented x 3
Mild dysarthria
Full with all 4 extremities
No pronator drift
Eyes open spontaneously
Incision C/D/I

From POD1
Alert and attentive; awake and oriented x 3; follow commands x 4
PERRL; smile symmetric; EOMI; facial sensation intact; no drift;
tongue midline; RLE, LLE, RUE = [**4-25**] motor; LUE = Deltoid (3),
bicep (2), tricep (2), wrist (3), grip (1)
mild dysarthria, incision c/d/i; neurologically stable s/p
subdural fluid drainage

Pertinent Results:
CTH [**11-6**]
1. New right inferior frontal lobe intraparenchymal hematoma
2. Status post drainage of right frontal subdural collection
with expected postoperative changes. Right lenticular hypodense
collection has resolved. Mild amount of right subdural hematoma
remains. Left subdural hematoma is unchanged.

CTH [**11-8**]
 Stable right intraparenchymal hematoma. Stable left subdural
hematoma.


Brief Hospital Course:
Patient was admitted to Neurosurgery service s/p right
craniotomy for treatment and diagnosis of a right subdural
collection which was found to be a right subdural abscess.  The
patient tolerated the procedure well with an EBL of 400.  For
further detail of the procedure please refer to the operative
note.  He was en route back to the PACU post operatively when he
had atonic clonic seizure, loaded with dilantin and admitted to
the SICU for monitoring.  On POD1, subdural JP drain was d/c'd
without complication.  The POD2 CTH was stable and the patient
was transfered out of the SICU to stepdown on POD 3.  ID was
consulted and managed pt with vanco and ceftaz until cultures
were back.  A PICC line was placed [**1-23**] difficult access and the
initial thought that the patient would require long term abx. On
[**11-11**] abx were discontinued. The patient also developed urinary
retention on [**11-11**] and required catheterization.  The patient
had complaints of left shoulder pain that was an acute
exacerbation of his chronic shoulder pain.  Xrays revealed no
fracture or dislocation.  Ortho was consulted and recommended
outpatient treatment of shoulder pain.  Physical therapy
recommended rehab.  On [**11-14**], the picc line was dislodged and
subsequent xray showed slight proximal migration of catheter
tip.  Upon discharge to rehab, the patient is afebrile with all
vitals stable, tolerating po feeds, with impaired strength and
balance, and with pain controlled on po pain medication.

Medications on Admission:
ASA 325, Darvan, flomax, lisinopril, metoprolol, proventil,
spiriva, prednisone, protonix, simvastatin, diasepam, neb

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed.
3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
6. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
7. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Propoxyphene N-Acetaminophen 100-650 mg Tablet Sig: One (1)
Tablet PO Q6H (every 6 hours) as needed for pain.
9. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
10. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours).
11. Phenytoin 50 mg Tablet, Chewable Sig: Three (3) Tablet,
Chewable PO TID (3 times a day).
12. Hydromorphone 4 mg Tablet Sig: One (1) Tablet PO Q3H (every
3 hours) as needed for pain.
13. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
14. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
15. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
16. Ondansetron 4 mg IV Q8H:PRN
17. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
18. HydrALAzine 10 mg IV Q6H:PRN SBP>140
19. Heparin Flush PICC (100 units/ml) 2 ml IV DAILY:PRN
10 ml NS followed by 2 ml of 100 Units/ml heparin (200 units
heparin) each lumen Daily and PRN.  Inspect site every shift.
20. Insulin Lispro 100 unit/mL Solution Sig: One (1) Units per
sliding scale Subcutaneous ASDIR (AS DIRECTED): As directed per
sliding scale.


Discharge Disposition:
Extended Care

Facility:
Life Care Center of [**Location 15289**]

Discharge Diagnosis:
Right subdural empyema with central necrosis.


Discharge Condition:
Stable


Discharge Instructions:
??????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 [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR.
[**Last Name (STitle) 739**] TO BE SEEN IN 4 WEEKS.
YOU WILL NEED A CAT SCAN OF THE BRAIN WITHOUT CONTRAST


                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]
{'Infection and inflammatory reaction due to nervous system device, implant, and graft,Intracranial abscess,Other convulsions,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Bipolar disorder, unspecified,Chronic obstructive asthma, unspecified,Long-term (current) use of steroids,Abdominal aneurysm without mention of rupture,Posttraumatic stress disorder,Pure hypercholesterolemia,Unspecified essential hypertension,Attention deficit disorder with hyperactivity'}


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: Right subdural collection

PRESENT ILLNESS: The patient is a 55-year-old male with a history of shunt and
revision in the past. About 2 to 3 months ago, the patient had a
shunt infection and the whole
shunt was removed by Dr. [**Last Name (STitle) **]. However, at that point, the
subdural collection was left intact. The patient was given
antibiotics for long-term. The patient followed up with me, and
he had a CAT scan as well as an MRI. Initially, the patient
refused the proposed surgery due to my suspicion that
this was representing an abscess. He continued with antibiotic
treatment. However, the patient started to deteriorate
neurologically, with difficulty with speech and also weakness of
the left side. An MRI showed enhancement of
that collection with what seemed to be a very thick membrane.
Then finally, the patient agreed to surgery.

MEDICAL HISTORY: -[**2109-12-13**] Cardiac Catheterization - LAD with proximal 40% and
mid
70% stenosis. Ramus with a large mid 90% stenosis was stented
with 2.5 x 23mm CYPHER DES and 3 x 13mm CYPHER DES with TIMI 3
flow. RCA was occluded in the mid segment and could not be
engaged but was filled with left-right callaterals.
-Bipolar
- NPH status post Right VP shunt in [**6-26**] and revision [**9-26**]
-Asthma
-ADHD
-High Cholesterol
-HTN
-PTSD
-AAA
- DJD
PSH: [**Name (NI) 10259**], PTCA, VP shunt [**6-26**] (Dr. [**First Name (STitle) **]/[**Hospital1 336**]), revision of VP
shunt [**9-26**] (Dr. [**Last Name (STitle) **]/[**Hospital1 18**])

MEDICATION ON ADMISSION: ASA 325, Darvan, flomax, lisinopril, metoprolol, proventil,
spiriva, prednisone, protonix, simvastatin, diasepam, neb

ALLERGIES: Levofloxacin / Codeine / Iodine; Iodine Containing / Oxycodone /
Hydrocodone

PHYSICAL EXAM: From post op check
99.1  75  15  132/74
Alert and oriented x 3
Mild dysarthria
Full with all 4 extremities
No pronator drift
Eyes open spontaneously
Incision C/D/I

FAMILY HISTORY: (+) [**Name (NI) 41900**] CAD Father has CAD and CHF. Social History: Married
for 15 years with two children 10 daughter and 14 son.

SOCIAL HISTORY: (+) cigarette smoking -quit in [**11-25**] 60ppy history, [**12-24**] ppd
on and off for 40 years 

### Response:
{'Infection and inflammatory reaction due to nervous system device, implant, and graft,Intracranial abscess,Other convulsions,Retention of urine, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Bipolar disorder, unspecified,Chronic obstructive asthma, unspecified,Long-term (current) use of steroids,Abdominal aneurysm without mention of rupture,Posttraumatic stress disorder,Pure hypercholesterolemia,Unspecified essential hypertension,Attention deficit disorder with hyperactivity'}
