I can see the status bar

Chapter 724 Surprise
Judging from the symptoms of Tang Min, who was named Nannan from a young age, there are two main directions of Sun Lien's suspicions.

First, it may be a genetic disease.Judging from the age of onset, children are definitely a high-risk group of genetic diseases.And the widespread presence of lesions in the nervous system also seems to suggest that these diseased areas have some common characteristics.

Second, if it is not a genetic disease, then this may be some kind of malignant tumor that widely exists in Tang Min's central nervous system.From the perspective of invading the optic nerve and extensive space-occupying lesions in the brain, combined with the mild hyperplasia of glial cells, it may be... some kind of tumor that appeared in the brain at the same time, but still belonged to the early stage of the disease.

But both hypotheses are currently very fragile and untenable.If it is a genetic disease, then the current lesion area seems to be more extensive - and Sun Li'en can't find a reasonable logic to explain why Tang Min's disease occurred at this time point.

If it is a tumor, it is very unscientific that the two brain biopsies did not detect cancer cells. This is not the era when doctors thought that pheochromocytoma only appeared in the adrenal gland.In the case where the space-occupying lesion was clearly identified by imaging and the biopsy was sampled by a high-precision neurosurgical robot, no cancer cells were found twice in a row... This is simply a fantasy.

Most researchers who engage in scientific research need the basic mentality of "bold assumptions, careful verification".But Sun Lien's problem now is that, in the face of a bunch of obvious evidence, he can't come up with anything that can be called a "hypothesis".With the current strength of evidence, whether it is a genetic disease or a suspected direction of tumors, it is more like some kind of sleepwalking than a hypothesis.

There is a lot of evidence that needs to be added, and there are still many places that need to be improved.But these problems can be relied on first.After pondering for a moment, Sun Li'en decided to treat Tang Min with intracranial decompression first.

Cerebellar tonsillar herniation is a life-threatening condition.Even though it has lasted thousands of hours, it is still a problem that cannot be ignored.Anyway, there is no new progress in the diagnosis for the time being, so it would be good to control the intracranial pressure first and improve the compression of Tang Min's brain tissue - at least it will not have any serious side effects.

Of course, controlling intracranial pressure requires some indications first.And this indication was soon reflected in CT.

"Type I cerebellar tonsil hernia." The imaging department immediately noticed the problem, and brought it up to Sun Lien, who was in charge of the inspection, "The situation is not too serious—the cerebellar tonsil enters the foramen magnum about 6 mm, and the fourth ventricle and medulla oblongata slightly elongated."

"Understood." Sun Li'en nodded, and then asked, "Any other questions?"

"She has undergone lateral ventricle drainage." The doctor in the imaging department said after carefully reviewing the CT examination results, "Uh... her optic nerve is a bit meandering, and it may be necessary to do an optic nerve potential map to clarify the nature."

The doctors in the imaging department had already performed at a super level. After Sun Lien took out his notebook and wrote it down, he asked Zhou Ce to continue the examination, and he returned to the office and began to issue doctor's orders.

Intravenous infusion of 125ml mannitol... When writing this, Sun Lien still feels a little kind.Since he entered the Comprehensive Diagnostic Center, he used mannitol less and less frequently.Sun Lien wrote the doctor's order while thinking about the "turbulent waves" of emergency life in the past.Then he thought about it and called Qian Hongjun.

"Director Qian, I have a patient here, and the situation is more complicated..." After Qian Hongjun answered the phone, Sun Lien didn't ask him if it was convenient for him to speak now.He quickly described the basic situation in a relatively short language and then asked, "Although her cerebellar tonsil herniation has not caused any serious consequences, I still think it is better to control the intracranial pressure first—is the dosage of 125ml enough?" ?”

For adults with cerebellar tonsil hernia, 250ml of mannitol is generally used.And after controlling the intracranial pressure and preventing the herniated tissue from compressing the medulla oblongata and the brainstem, the cause of the elevated intracranial pressure should be resolved as soon as possible.But... Considering the actual situation, Tang Min is only seven years old, and she has no cause of increased intracranial pressure that can be solved by surgery-what the cause is is still a mystery.

It's a dilemma, and there is no proper way to solve this problem.Apart from using mannitol first, Sun Lien really didn't have any particularly suitable means to deal with it.Moreover, looking at the appearance of Tang Min's parents, Sun Li'en felt that he had to do something first to reassure them a little.

Treatment is a very complex process.In addition to treating the patient, sometimes the patient's family is also the object of treatment.

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Yuan Pingan has not been idle since he received Sun Lien's instructions at one o'clock in the noon.He first called his teacher Zhu Minhua in the Tongxie for help, then followed Zhu Minhua's instructions and made continuous phone calls for more than an hour, and finally received Tang Min's case from the Tongxie.

The PDF file of the case is as long as 174 pages, plus the various radiology and pathology pictures inside, the size is more than 400 megabytes.According to Sun Li'en's request, this case must at least reach the point where the doctors in the diagnostic department have a copy.Therefore, Yuan Pingan, a master of neurosurgery and doctor of emergency department who graduated from the Tangtang Tongxie, became Secretary Yuan running around in the office.There are a total of three printers in the offices of the two diagnostic groups.After working for two hours, these three machines all declared "consumables exhausted".

After calling the General Affairs Office to ask for a replacement, Yuan Ping'an looked at the four medical records that had just been printed out in his hand, and then resolutely decided to take the USB flash drive to the quick printing shop outside to complete the rest of the work.

Yuan Ping'an knew better than Sun Li'en how strong the neurology department of Tongxie was.Although he has full confidence in his own team leader, Yuan Ping'an still believes that this patient is definitely a difficult case.

He had never seen Sun Li'en deal with any case like an enemy before.In his previous work, Sun Li'en always went to see the patients first, and after collecting the medical history, he arranged for the examination based on the basis.According to Yuan Ping'an's observation, as long as Sun Li'en puts forward the inspection request, it is basically certain that he has a very reliable diagnosis direction.

But this time things were different.Sun Li'en basically did all the inspections he could do in one go.Of course, this move can be understood as Takeda Pharmaceutical is indeed a particularly rich taker.But Yuan Ping'an still felt... Sun Li'en was a little flustered.

It is not uncommon for panic to happen to doctors.But it's very rare to happen to Sun Li'en - this guy used to be very confident.

With a trace of sympathy for Sun Lien in his heart, Yuan Pingan put on the doctor's clothes, pushed open the door of the office and walked out.As a result, as soon as he went out, he bumped into someone outside the door.Yuan Ping'an covered his sore nose that had been bumped, and it took him a long time to change it.He squinted his eyes and was about to complain that the other party walked too carelessly, but when he saw someone coming, he immediately forgot the unbearable soreness on his nose.

"Doctor Xu, are you back?"

　A little earlier today too - this case is more complex and I'm still discussing the latter with my consultant.

　　After the story of this case is completely over, Sanguan will issue a separate chapter to explain to you what is "complex" about this case.

　　
　
(End of this chapter)