My medical skills add experience

Chapter 612 The spinal cord is a restricted area for nerves, a female patient with double vision

It is definitely a kind of luck for the patient to meet a doctor like Zhou Can.

He is responsible, compassionate, professional and well connected.When encountering difficult cases, we can often consult with top experts from the corresponding departments as soon as possible.

Yin Hua picked up the information and checked it carefully, and did not make comments easily.

Almost all experts are in this tone.

Unsure of the condition will never express opinions indiscriminately, they can control their mouths very well.

It's not like some young novice doctors who are eager to claim credit at the slightest discovery, eager to show their medical skills.This is exactly what people often say when a full bottle is silent, and a half bottle of water dangles.

The more powerful a person is, the more humble he is.

People without strength are particularly vain because of low self-esteem.

Zhou Can picked up his cup to drink tea, and patiently waited for Director Yin Hua to finish reading the materials.

"There are only two reasons for this child's paraplegia, either trauma to the cervical spine or brain injury."

Director Yin Hua gave a diagnosis opinion after careful study.

"Do you think so? At the beginning, I suspected that the patient's cervical spine injury caused high paraplegia. Because the patient's neck had been red and swollen after the fall."

Before Zhou Can came, he naturally had a certain diagnosis.

Director Yin nodded.

"The spinal cord is hidden in the cervical spine, which is an important part of the human nerves. It is almost impossible to recover from a spinal cord injury. If the spinal cord is damaged, the child may not have a chance to heal again."

Director Yin has rich clinical experience and has seen various cases.

Many half-doctors only know that the brain stem is a forbidden area of ​​life, but experienced surgeons or neurologists think that the spinal cord is more fragile than the brain stem and more difficult to repair.

If the brainstem is called a restricted area of ​​life, the spinal cord is absolutely qualified to be called a restricted area for nerves.

Ordinary nerves are severed or damaged, and doctors can perform nerve anastomosis with superb medical skills.However, if the spinal cord is injured, the best result is lower body paralysis, and it is likely to be paralyzed for life.

It will be difficult for me to get up from a wheelchair in my life.

Speaking of this, we must talk about lumbar puncture and bone marrow puncture among the four clinical punctures.

Many patients think that lumbar puncture is very dangerous, because the tissues it needs to pass through are skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, and ligamentum flavum, that is, the epidural space. Generally speaking, epidural anesthesia is here.

Then continue to insert the needle to penetrate the dura mater and arachnoid, and enter the subarachnoid space until the cerebrospinal fluid flows out.

Patients believe that lumbar puncture is dangerous, mainly due to misunderstanding of the cognition of spinal anesthesia.

After spinal anesthesia, the lower limbs completely lose consciousness, feeling no different from lower limb paralysis.

Therefore, many patients think that if the lumbar puncture is not performed well, it will paralyze him.There is such a possibility, but very slim.

There will be two times of feeling empty when the waist is pierced. As long as the hand feeling is not too bad, doctors with a fairly flexible mind can basically learn it.And some of the main points, with the teacher
, Superior doctors will explain in detail, and will strictly guide during the actual operation.

After all, everyone is afraid of accidents.

Really let the intern doctor and Gui Peisheng paralyze the patient, no one can afford the consequences.

Therefore, relatively speaking, lumbar puncture is a very safe type of puncture.

On the contrary, it is the bone marrow puncture that is not paid attention to, and there is a kind of spinal process called spinous process.The risk of this puncture is even higher.

Especially when encountering a novice doctor who doesn't know the depth and is fearless, the patient can sternly refuse it out of consideration for physical safety.Let the superior doctor operate, instead of being treated as a guinea pig.

If something goes wrong, it will ruin your life.

Of course, the chances of something going wrong are less than 99.9%.It may be difficult to have a problem once in ten thousand times.

Even if this probability is one in ten thousand, it will be a disaster for any patient.

It can be avoided, and it must be avoided.

For some dangerous operations, when the patient strongly raises doubts, the superior doctor who is skilled in this technique is obliged to perform the operation himself.Instead of dumping it on the interns.

"The nerves of the human body are divided into two parts, the central nervous system and the peripheral nervous system. Clinically, the nerve anastomosis can be performed, and it is generally the peripheral nervous system. The central nervous system is generally difficult to repair surgically. At least with the current medical technology and level , the central nervous system is still an untapped field. The spinal cord is part of the central nervous system."

Director Yin Hua continued to explain to Zhou Can the experience of clinical diagnosis and treatment of nerves.

"The length of the spinal cord of an adult is generally about 42cm to 45cm. It is hidden deep inside the spine and is generally not easy to be damaged. This is also a self-protection formed by us humans, even more than most mammals, during countless years of evolution. .”

In addition to supporting the body, bones also have another function, which is to protect important organs and nerves.

For example, our most important brain is wrapped by the entire skull and forms a spherical shape.

This is also the result of long-term natural evolution.

The round shape is the least vulnerable to damage, and the hard skull grows into a spherical shape, which can protect the brain and important brain tissues to the greatest extent.

The evolution of the spine is more interesting, the spine is round, but the spine is somewhat triangular.

The round shape is not easily damaged by external force, and can defuse external force attacks to the greatest extent.Even plants have learned this through evolution.The trunks of trees are almost uniformly cylindrical.

Because the cylindrical shape is more stable, it is not easy to break or be damaged by external forces.

The trunk must support the weight of the entire canopy, branches and leaves, and must be cylindrical without breaking in harsh environments such as strong winds and heavy snow.

Perhaps at the earliest time, some trees had non-circular trunks, but they were eliminated in the natural competition.

So now all you can see is the cylindrical trunk.

The evolution of the spine into a circular shape is definitely an evolution that is most in line with nature and adapts to the way of heaven.

The spine is a bit like a triangle, which is also the result of natural evolution.

The triangle is the most stable form.

For the spine to support the entire upper body, it must be stable and secure.

"If the spinal cord is injured, my clinical experience is that the closer to the head, the lower the possibility of recovery. In clinical practice, some patients with spinal cord injuries and paralysis of the lower limbs can finally stand up again after tenacious rehabilitation training, and return to their original state. Motor function, neurological function. In most cases, it is because the injured spinal cord is close to the tailbone."

There is no such thing as a coccyx in medicine.

But older doctors often refer to the spine near the buttocks as the tailbone.

Humans should have had tails at the beginning.

Because it turns out that the vast majority of animals have tails.

It's just that in the process of human evolution, the tail finally disappeared.The body also becomes smooth, leaving only the skin.

To be honest, this kind of evolution of human beings is not good for adapting to the harsh environment of nature, but human beings have evolved advanced civilizations.Food and clothing are settled, there is a house to live in, and there are cars, planes, ships and other means of transportation for travel.It is a natural miracle that you no longer need to be exposed to the wind and rain like wild animals, run around and hunt in the virgin forest, and evolve towards a more beautiful direction.

Looking at all animals, except for humans, other animals either have thick scales, turtle shells for protection, or have thick hair or even spikes for protection.

Whether there are gods in this world, no one knows.

But human beings are the most outstanding species on earth, and there is absolutely no need to question them.

Just imagine, if our girlfriend is a person covered with black hair, how would it feel?Some male compatriots have particularly strong body hair because of excessive male hormones.

Arms, chest, abdomen, legs, etc. are covered with long hair.

Does this mean that evolution is slow?
No one can tell.

Studies have shown that men with thick body hair are stronger and have stronger body immunity.The ability to lead a married life should also be stronger.

The immune ability of wild animals is definitely stronger than that of humans. From another perspective, it can also be understood that male compatriots with vigorous hair have not evolved as well as male compatriots with smooth skin and tender flesh.

In the Bible and many Western mythological books, angels are described as fair-skinned and beautiful, rather than black-haired, like apes.

When Director Yin Hua shared his clinical experience, Zhou Can just listened quietly.

He learned another thing today, the closer the spinal cord is injured to the head, the harder it is to recover.

"Director Yin, I did a test for this child, that is, the knee bounce response. After testing, I found that the knee bounce reflex of both legs exists, which shows that the lower nerve center should be unobstructed. It's just that his The knee jerk reflex in the left leg is normal, but the right leg is significantly weaker. At the same time, I also found that there is stiffness in his right neck..."

Zhou Can also explained his own analysis and discovery.

"what do you mean?"

After Director Yin finished listening, his eyes lit up slightly, and a smile of appreciation appeared on his face.

Zhou Can often has some unexpected methods in diagnosis.

In his hands, many seemingly ordinary methods can turn decay into magic, and become the key ideas to solve difficult cases.

"I suspect that the high paraplegia is not caused by cervical spine injury. But as you said, there are only two parts that can cause high paraplegia, either the cervical spine or the head. You have also seen the patient's head CT and color Doppler ultrasound, almost no Any abnormalities. I seem to have entered an endless loop in the diagnosis, so I came here to ask you for advice."

Zhou Can is most afraid of encountering this kind of endless loop in clinical diagnosis.

A diagnostic clue was found with difficulty, only to turn out, after much effort, to be wrong.

It is conceivable that the doctor must be desperate in this situation.

Find a clue, determine the direction of diagnosis, and then perform a series of examinations on the patient, and even ask other doctors for consultation in the process.In the end, it was found that this diagnosis was unreasonable.

At this time, either give up.

Either find a way to find other diagnostic ideas again.

"That's all right. I'll go to the ward to see the actual condition of the child. Neck stiffness usually doesn't occur on one side, but on both sides at the same time. This should be one of the clues for a breakthrough in diagnosis."

Director Yin thought for a while before saying.

"Okay, I'll accompany you to the ward. The child lives in the emergency surgery ward."

Zhou Can stood up and said to him.

Director Yin hurriedly raised his hand and pressed down, signaling Zhou Can to sit down.

"Don't, don't, just sit in my office. I also have a difficult case here, and I don't have any thoughts. You can help with the research." After he finished speaking, he directly handed the patient's information to Zhou Can.

The two are exchanged.

It's not like this happened once or twice.

Zhou Can asked another chief physician for help, why did he respond to his request?
Because after they helped Zhou Can, when they encountered problems, they asked Zhou Can to help, and they also responded to their requests.

Sitting in Director Yin's spacious office, Zhou Can studied the patient's information while drinking tea.

This is a female patient, only 32 years old, quite young.

The patient's main complaints on admission were headache, blurred vision, and often seeing things as double images.Limbs sometimes twitch.

Just after reading the main symptoms, the first thing Zhou Can thought of was epilepsy, which is often called epilepsy in medicine.

The disease is both hereditary and acquired.

Although the disease is prone to genetics, it is not contagious to others.So after looking for a partner, you don't need to be afraid if you find out that the other person has epilepsy.As long as you take good care of each other when they get sick, this will increase your mutual affection.

The danger is most likely to occur during a seizure.

For example, when riding a bicycle, a sudden seizure occurs, the whole person loses consciousness, and it is easy to hit an obstacle on the side of the road, and then fall down.

If it is on the edge of rivers and ponds, if it falls into the water, drowning will occur.

If you are engaged in some dangerous work, such as working next to the machine, after losing consciousness, you will be caught in the machine and will be directly smashed into meat.

In general, epilepsy can be controlled with medication to reduce seizures.

Even let it not happen.

This fee is high and lasts a lifetime.There are many families who cannot afford it or are unwilling to afford it.

Zhou Can first checked the case to see if the patient had a family genetic history.

The female patient's parents and grandparents are all in good health, without diseases such as epilepsy, and have no history of mental illness.

Only her grandmother developed senile dementia in her old age, which is often called Alzheimer's disease in medicine.

This disease is completely irrelevant to the woman's disease and can be ignored.

After excluding the genetic medical history, Zhou Can began to carefully study the examination results and course of the disease of the female patient.

This is the first time the disease has occurred in a female patient.

About two months ago, she started having headaches.At that time, because of her busy work and a lot of housework at home, she needed to take care of it, so she didn't go to the hospital for an examination.

At first I thought I hadn't had a good rest, thinking that I would heal myself after a while, so I didn't take any medicine and went to the doctor.

As a result, the headache lasted for about a month, and instead of getting better, her condition began to worsen.The vision becomes a double image.

In the beginning, it was just occasional double vision, especially when I first woke up in the morning.

Later, the condition worsened again, not only the headache became more severe, but double vision became normal.And also limb twitching.

However, there was no foaming at the mouth.

If it is the legendary pig woman madness, foaming at the mouth will usually appear when the onset occurs.

Seeing this, Zhou Can felt that the female patient's illness was not simple. No wonder Director Yin Hua and neurology doctors failed to find out the cause.

(End of this chapter)