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Chapter 739 A Proven Direction
It took some time to read the case, but Dr. Pascal read it much faster than Sun Lien expected.After about 10 or [-] minutes, Dr. Pascal, who had only seen half of the case, put down the things in his hand, frowned and asked, "This patient...is a bit strange."

"Of course it's strange." Sun Li'en nodded. "The two biopsies failed to find anything of value, which is very unusual in itself—the sampling was taken directly from the occupied area shown on the image."

"These occupying areas are not necessarily real occupying areas." Dr. Pascal pointed to Sun Lien's case in his hand, "Inflammation may also appear as a low signal area on MRI."

"Inflammation?" Sun Li'en frowned, "Do you think... this might be... some kind of autoimmune disease?"

Dr. Pascale spread his hands, "Ask an oncologist about this kind of question, and he will say it's glioma multiplex; ask a genetic disease doctor, and he'll tell you that it's some kind of genetic disease whose name the devil knows. I have indeed seen patients with similar symptoms before. So if you ask me today, of course I think this may be an autoimmune system disease-it doesn’t matter what we say, what matters is how you should verify our statement " He stared at Sun Lien and said seriously, "We can only provide ideas, and it is your job to identify and verify these ideas."

Sun Lien was still trying to absorb and digest Dr. Pascal's answer, while Old Pa continued to say, "From the analysis of the area of ​​the lesion, these occupiers are basically close to the lateral ventricle and around the main blood vessels. And the spine below I have a different opinion about the shadows."

The report of the imaging examination did mention multiple low signal shadows.This low-signal shadow was interpreted as a "space-occupying lesion" by doctors in the imaging department.However, Dr. Pascale has a different view on this.

"The low signal shadow on MRI generally appears in the place where the water content is significantly higher than that of other tissues." He explained to Sun Lien, "As mentioned in the biopsy, the interstitium showed slight edema under the microscope-this can also be used to explain the low signal. origin of."

Sun Lien glanced at the case again, then shook his head, "If it is interstitial cerebral edema, then its imaging features should be manifested as striped shadows with clear borders around the ventricle-this is consistent with the existing images with multiple low signals. The medical evidence does not match. Moreover, Yuanhai Hospital has performed lateral ventricle drainage on the child. If the lesion is caused by interstitial cerebral edema, her condition should at least stabilize after lateral ventricle drainage instead of further deterioration."

"I'm just saying that these areas may be edema, but not necessarily interstitial cerebral edema." Dr. Pascal shook his head, "I have a bold idea—but just wait." He lowered his head, and I started to flip through the previous case, and started to draw on it with the pen in my pocket.Soon, he finished his marking work and said, "The child received six consecutive days of hormone shock therapy after the first admission, but the treatment did not work well."

Sun Lien knew about this, he nodded, "And then?"

"Then the hospital conducted the first AQP4 antibody test on the child, and the test result was negative." Dr. Pascal continued to read with his head down, "One month later, the child was discharged. After two weeks, they were transferred to Go to another hospital to start treatment - the new hospital has adopted a similar strategy, hormone shock."

The logic of the doctors in these hospitals is actually similar to Dr. Pascal's hypothesis. They all think that these low signal areas may not be really tumors, but are more likely to be sterile inflammatory reactions.Therefore, the first treatment plan to be adopted is hormone shock therapy.It's just that the two hospitals have adopted different hormone drugs and dosages.

"The third, the fourth... Even the Tongxie Hospital in the capital has adopted a hormone-shocking treatment plan." Dr. Pascal shook his head and said, "But they all did nothing."

This sounds like a mere description of previous treatment.Sun Li'en frowned and thought about it, but he didn't find any problem.

"They all made a mistake - try to control the disease first, and then improve the relevant examinations." Dr. Pascal shook his head and said, "Under hormone shock therapy, the first thing that affects is the AQP4 antibody." He looked at Sun Lien and said seriously, "I I feel that at least NMO cannot be ruled out so easily."

Neuromyelitis optica spectrum disorder (neuromyelitis optica, NMO), was a suspected target that was initially ruled out throughout the treatment process.The reason is also very simple-many hospitals have carried out related tests for Tang Min, and the AQP4 antibody tests have always been negative.

"Negative antibody does not mean that she does not have NMO." Facing Sun Lien's question, Dr. Pascal simply shook his head and said, "Some NMO patients will have false negatives of AQP4 antibody after receiving hormone shock. And these people ..." He suddenly showed a somewhat mysterious smile, "They also have one characteristic in common."

"They are all insensitive to hormone shock therapy?" Sun Lien guessed along Dr. Pascal's train of thought, and then got an affirmative answer.

"For such patients, the effect of plasma exchange will be much better." Dr. Pascale nodded and handed back the medical records, "I think that if NMO is to be ruled out, plasma exchange should be done at least twice to see the effect .”

After hesitating for a while, Sun Lien put the case handed over by Dr. Pascal aside. "This matter... I still think something is wrong."

Neuromyelitis optica spectrum disorder gets its name because the diagnosis requires an inflammatory response in both the optic nerve and parts of the spinal cord.Taking a step back, assuming that Tang Min is really an NMO patient with negative AQP4 antibody, then she should also show symptoms of myelitis.But she currently shows no signs of myelitis -- neither imaging nor actual symptoms are available.Under such conditions, it is completely impossible to determine that Tang Min is an NMO patient.

"A recent MRI scan also confirmed that she has no signs of spinal cord inflammation." Sun Lien added, "NMO patients who are negative for AQP4 antibodies must first meet the conditions for NMO, right?"

"I'm not sure about that." Dr. Pascal said in a very bachelor way, "Anyway, since you don't have any other particularly valuable ideas right now, why don't you consider it? At least give her two plasma exchanges to see. He looked helpless looking at the case on the table, "Even if the plasma exchange has no effect, her condition will not be worse. At least this is a well-founded treatment direction, isn't it?"

　The chance of the second update today is about half and half, and I can't say whether I can write new content today.

　　
　
(End of this chapter)