"Isn't this patient's main symptoms fever and chills?"

Many people have doubts in their hearts.

Infectious diseases of the brain can indeed cause similar symptoms.

Even brain tumors can cause these two symptoms.

However, the patient's infection indicators were very low, and the brain CT showed no abnormalities except for softening lesions. Obviously, it could not be caused by these two common diseases.

Thumb thump thump——

At this time, footsteps sounded outside the conference room.

Everyone stood in silence at the same time. As the door was pushed open, everyone looked at the door with a hint of respect in their eyes.

"Doctor Xu!"

Director Shen, Director Lin and others stood up.

After Xu Qiu sat down, she didn't waste any time and quickly started the consultation.

"What, not a chill?"

"Isn't fever really fever?"

Director Shen and others looked at each other in confusion.

Before the consultation, they all went to the ward to see the patient.

This is also the habit of many doctors - meeting real patients is always more profound than reading boring medical records.

At that time, Director Shen, Director Lin and others gave the same judgment.

It's fever, chills, muscle weakness, etc.

But now, Xu Qiu directly denied these two symptoms as soon as he came up?

Everyone looked at Xu Qiu, wanting to see how he would explain.

"Let's talk about fever first."

Xu Qiu didn't sell it, but pointed out the key points directly: "In my judgment, the patient does not have a real fever, but focal epilepsy."

Director Shen and others looked surprised.

"Focal epilepsy?"

"So... tremors are also caused by focal epilepsy?"

Doctors inside and outside the brain also find it a bit unbelievable.

Focal epilepsy is relative to generalized epilepsy. It is generally just a partial seizure caused by local lesions in the cerebral cortex. It is mainly divided into two clinical manifestations.

One is a sensory attack.

There is generally a pattern of onset, that is, abnormal sensations begin from the corner of the mouth, toes and other parts of one side, such as pinprick sensations, burning sensations, electric shock sensations, etc., and may even produce the wrong feeling of missing limbs...

In addition, auditory hallucinations, olfactory attacks, etc. may occur.

The second is a motor seizure, which behaves like Wei Ding's, with mild and inconspicuous muscle twitching in the body. Of course, when focal epilepsy is severe, it may also cause severe muscle twitching.

"Then...how do you explain muscle weakness?" Director Shen asked seriously.

Muscle twitching and muscle weakness are completely different symptoms.

I'm afraid it can't be explained clearly with a focal epilepsy.

"There's no way to explain it."

As soon as Xu Qiu finished speaking, before everyone could show their confused expressions, he continued: "The patient is not just suffering from localized epilepsy, the muscle weakness is caused by other reasons."

“Transverse Myelitis!”

As soon as the disease emerged, the expressions of Director Shen and others immediately became serious.

Transverse myelitis and focal epilepsy are two very different brain diseases.

It also has another name, acute myelitis.

According to textbooks, it often occurs during acute infection or a few weeks after vaccination. It is characterized by infection first, followed by acute onset.

Once the disease begins, it will quickly cause transverse damage to the spinal cord, causing numbness, weakness, loss of sensation, and even paralysis in the limbs below the level of the lesion.

Although the medical record does not indicate that the patient has a history of acute infection or vaccination, clinical practice is not as rigid as a medical student exam. As long as the symptoms are correct, the indicators are okay, and other diseases are ruled out, acute myelitis will naturally be suspected.

It's just...further inspections are still on the way. How did Xu Qiu make this conclusion?

"Dr. Xu, you mean...the patient started to get sick from the lower limbs?"

"good."

Xu Qiu nodded and explained: "According to the characteristics of transverse myelitis, to be precise, it should start in the toes on the right side, then spread to both lower limbs, causing numbness in the lower limbs, and then develop into severe muscle weakness.

"And now, it has spread to both upper limbs."

After Xu Qiu finished speaking, he added: "The most critical point is that the patient's limbs have abnormal muscle tone, but the chest and abdomen are normal. This is completely consistent with the characteristics of transverse myelitis..."

Director Shen asked: "What about the cremasteric reflex?"

"Disappeared."

Director Shen was a little hesitant.

To diagnose transverse myelitis, there is actually another more important feature.

Early bowel obstruction!

The vast majority of patients with transverse myelitis will suffer from urinary and fecal incontinence in the early stages of the disease. In the early stage, it is urinary retention, and during the recovery period, it becomes stress urinary incontinence.

But... Wei Ding does not have this characteristic, and there is no mention of defecation or defecation disorders in the entire medical record.

In addition, there is no previous infection, so it is still difficult to diagnose this disease.

If it could be proven that muscle weakness does develop from the lower limbs, it would provide quite a bit of evidence.

"Dr. Xu, according to your diagnosis of transverse myelitis, then the next step is weakness in the lower limbs, weakness in the upper limbs, and then respiratory muscle weakness... Does the patient have breathing difficulties?"

"No." Xu Qiu looked at the door.

Director Shen looked back and found nothing, then turned back: "We can suspect transverse myelitis, but if we confirm the diagnosis directly, I think it is too arbitrary. It is safer to do a spinal MR..."

It was found that the spinal cord was swollen and had long T1 and long T2 signals, which also supported Xu Qiu's diagnosis.

Director Lin flipped through the medical records and said, "I see, Dr. Xu, you didn't make an appointment with MR? If you delay it until tomorrow, it will be detrimental to your condition."

The other doctors nodded.

They respect Xu Qiu very much.

But when it comes to treating diseases and saving people, authority and status are not important. In the face of diseases, only those who have mastered the disease are regarded as teachers.

Whoever is right and makes a reasonable diagnosis can question the chief physician even if he is an intern.

Of course, it is limited to hospitals with excellent medical ethics such as clinical medicine.

…

"It's not impossible to do a cerebrospinal fluid examination, but it's not easy to identify."

"Yes, I have treated more than a dozen patients with transverse myelitis. When the cerebrospinal fluid was extracted, the pressure was normal and the appearance was transparent. Only the cell count was slightly increased, and nothing could be seen at all."

"Doing a cerebrospinal fluid examination depends on luck. For some patients, if they happen to be in the acute stage of illness, spinal canal obstruction may be found, and the diagnosis can be confirmed."

"The diagnosis of transverse myelitis depends on the precursor symptoms, onset pattern, neurological signs and laboratory tests. Now the precursors are not matched, and no diagnostic laboratory tests have been done, and the neurological signs do not seem to be very consistent...

The onset of the disease is somewhat reasonable."

"Doctor Xu's diagnosis must be reasonable. We should ignore something."

"Believe it or not, it'll be over! Just treat it as acute myelitis!"

The doctors within the gods argued endlessly.

Focus on two issues.

1: How to determine whether the patient's weakness starts from the lower limbs and progresses upward;
Chapter completed!