I can see the status bar

Chapter 523
The case is from the Neurology Department of the Second Central Hospital. The patient is also surnamed Shen, male, and only 18 years old.

"This is my cousin." Shen Xi introduced, "He has always been in good health before, and he has never heard of any problems."

"Then epilepsy occurred suddenly?" Sun Lien quickly browsed the case brought by Shen Xi, "MRI plain scan showed that there were abnormal signals in the junction area on the right side, and the symptoms were also like epilepsy." He put down the case, "This There's nothing wrong with that."

"The problem is that there is nothing wrong with it." Shen Xi sighed, "The second hospital diagnosed symptomatic epilepsy, and I looked at the medical records, which also looked like epilepsy, but the second hospital gave phenobarbital and levetiracetam. It was treated with mannitol. But it didn't get any better, it started to get worse."

"What do you mean by severe? The frequency of epilepsy has become higher?" Xu Yourong became a little interested when he heard this, "Or does the epilepsy last longer each time?"

"During the treatment, there were three times of numbness and weakness in the left upper limb, followed by twitching of the limbs, and loss of consciousness. It was exactly the same as the previous symptoms before the seizure, and the left upper limb was still numb and weak after waking up. The current weakness has extended from the left finger to the forearm. The upper end." Shen Xi said seriously, "I don't think there is any serious problem with epileptic seizures many times, but the numbness of his upper limbs spreads, which I think is very strange."

His condition persisted, suggesting that standard treatments were not responding to his epilepsy.This may mean that Shen Xi's cousin's epilepsy is relatively stubborn, and the effect of phenobarbital and levetiracetam is not enough-maybe the medication regimen needs to be adjusted.But the smell of the progress of the disease is very wrong, which shows that the problem encountered by cousin Shen Xi is probably deeper than epilepsy, something caused his epilepsy, and the cause of the epilepsy has not been affected by Benzene. The effects of barbiturates and levetiracetam and even mannitol.Still getting worse.

Xu Yourong came over and looked down at the case in Sun Lien's hand.Sun Lien shifted his focus to the follow-up diagnosis plan of the Second Hospital.

"Are they suspecting poisoning?" Sun Li'en looked at the series of latest inspection reports in the case thoughtfully.The suspicion of the Second Court is indeed in one direction. This kind of numbness and weakness extending upward from the extremities is indeed similar to partial brain nerve damage caused by certain poisoning symptoms.Coupled with the case of Zhan Jun's brother Zhan Hao, who was regarded as simple demyelination and did not undergo follow-up examinations, Sun Lien has enough reason to believe that the neurologists of the Second Hospital were hung up by the director and whipped.

Otherwise, why would you suspect poisoning in the first place?This symptom is obviously wrong!Sun Li'en murmured in his heart that after leaving the poisoning environment, the symptoms of poisoning should improve.At that time, Zhan Hao's condition recurred because he ingested bacon containing lead for the second time.Any symptoms of intoxication should at least abate or stop progressing after leaving the toxic environment.Is there any thing that gets worse after leaving the poisoned environment?

If not intoxication, what is the cause of the epilepsy for which phenobarbital and levetiracetam have no effect?

The reasoning came to an abrupt end at this point.Sun Lien was frustrated to find that he didn't have the ability to continue reasoning - as an emergency doctor, he was not very familiar with these two drugs.This is especially true when analyzing the mechanism of action.This is actually unavoidable. There are probably hundreds of thousands of drugs used in the hospital. Except for old things, Sun Lien suspects that the entire Song'an Province and even the whole country will not be able to find a doctor who can memorize the mechanism of action of all drugs.

"I think there might be a problem with the direction of the poisoning." Sun Lien and Xu Yourong roughly exchanged a few words, and then said to Shen Xi who was a little anxious, "The Second Court may be a little too concerned about the previous mistakes..." Sun Lien actually said this I don't believe it. It is rare for a third-level hospital as big as the second hospital to specifically emphasize the diagnosis plan because of a single case.It is even more likely that the attending doctor who saw Shen Xi was the same one who saw Zhan Hao before - Zhan Hao's severe lead poisoning was able to pass under the nose of Dr. Shennei, and even almost caused a medical accident.This is bound to cause a serious psychological shadow on the doctor.

"Then what should we do? Brother Sun, can your department accept it?" Shen Xi revealed his true intention of coming here. His main purpose of bringing the case here is actually to let his cousin come to the diagnosis center for treatment. "The level of the Second Hospital... To be honest, I am not at ease."

The level of the second hospital is actually quite good.Although Sun Li'en really wanted to say that, but seeing that two consecutive cases fell into his hands in Shennei of the Second Hospital, it was really hard for him to say this.

"I think this case can be accepted." Xu Yourong, who was in charge of the preliminary review, simply took the case from Sun Li'en and began to read it in detail. A few minutes later, she gave her own opinion, "This progressive neurological disease of unknown cause has The value of intervention. The Second Hospital is a little less capable of dealing with this type of disease."

The translation is "This disease may be very dangerous, I can't trust the level of the Second Hospital".Sun Li'en nodded, since Xu Yourong said so, it seems that there is indeed value in the future.

"Okay, you can contact over there for a transfer." Sun Li'en nodded, he was also very curious about this patient.Of course, more importantly, he also wanted to know the origin of the epilepsy that neither phenobarbital nor levetiracetam worked. "Can you turn around today?"

"No problem." Shen Xi was overjoyed. He had long heard complaints from other seniors and teachers in the department that the acceptance standard of patients in the diagnosis center was unusually high.Originally, he didn't expect much from being transferred to the diagnosis center for medical treatment. He brought the case just to hear if Sun Li'en had any other opinions on his cousin's condition.Unexpectedly, it was actually a transfer. "I'll contact you now, and I'll send someone over before noon today!"

"Then go through the formalities first." Sun Li'en nodded, and pointed to the case in Xu Yourong's hand, "We'll make a copy of this case, and when the patient comes over, we'll take the latest inspection report from the Second Hospital. Come here." The internal level of the Second Hospital may not be very high, but the level of the laboratory department is quite good.With the ready-made inspection report, even if nothing abnormal was found, at least it could help Sun Lien and the others to eliminate some problems as soon as possible in the subsequent diagnosis.

After Shen Xi left, Brunn also came over.He couldn't read Chinese very well, but listening to Xu Yourong's retelling was not a big problem.After listening to the general content, he rubbed his chin thoughtfully, "This symptom description sounds like glove-like numbness."

"You suspect acute demyelination? The progress is a bit slow." Xu Yourong is not very optimistic about this opinion, "Glove-like numbness is usually symmetrical on both sides, and when the onset is already numb in the whole hand, his It's not going very well."

Sun Li'en also joined in the fun, "Many patients with glove-like numbness come to the doctor when their symptoms are obvious, and the main reason for this patient's admission is epilepsy--the symptoms of epilepsy are more obvious, could it be Because of this, admitted to the hospital and then discovered the developing glove numbness?"

"It's a bit far-fetched, but it makes sense." Xu Yourong nodded, "Do you think the cause of his glove-like numbness is directly related to epilepsy?"

"You don't think so?" Sun Lien's eyes widened, "I thought you were transferred to another hospital because of this."

Xu Yourong shook his head, "You think epilepsy is caused by the numbness of the left limb. I suspect that there is a more fundamental reason that causes epilepsy and numbness at the same time." This explanation was a bit of a mouthful, but Sun Lien still understood what Xu Yourong said Meaning——Epileptic is a manifestation of abnormal discharge in some areas of the brain. Xu Yourong felt that some kind of disease caused the abnormal discharge, and it progressed to numbness on one side of the patient's limb.Sun Lien's judgment is that the numbness of the limbs and the abnormal discharge in the brain are actually abnormalities in the same area.Both inferences can be established under the existing evidence, but the diagnostic directions and ideas guided by the two inferences are quite different.

(End of this chapter)