Chapter 365 Neglected examination, diagnostic clues!
In this situation, sending the patient to Meiguo, where medical technology is more developed and instruments are more advanced, is obviously a better choice.
"Multiple sclerosis can definitely be ruled out." Director Huo frowned and said.
Stereotactic brain biopsy showed no evidence of multiple sclerosis, which basically ruled it out.
The consultation lasted for more than half an hour.
Each director proposed different solutions.
Some said to go beyond the scope of neurology, focus on a wider spectrum of diseases, and try to find clues from the whole body.
Others believed that diagnostic treatment should be used, various drugs should be used to cover, and the cause of the disease should be inferred through the efficacy of the drugs.
However, Xu Qiu rejected all of them.
His opinion was to return to the patient's medical history and to examine the patient again.
Many clues of difficult and complicated diseases are often hidden in previous manifestations.
And the re-examination is to hope that more specific symptoms will appear after the disease progresses.
"Do another EEG." Xu Qiu said.
At the end of the road, the next diagnostic procedure is to repeat the examination and the clinical examination.
"Still suspecting brain disease?" Joseph squinted his eyes and muttered.
At this juncture, he went to recheck the EEG, most likely to confirm the two contradictory tests.
He couldn't understand.
How could it be viral encephalitis if no pathogen was found?
But, Joseph was only a doctor who came here for further training after all. No matter how high his status in cardiac surgery was, he still had to listen to Xu Qiu in the emergency department.
After the meeting, the medical staff immediately returned to the ward to hand over to Fan Fuguo and did another EEG.
And Xu Qiu returned to the office with a thick stack of medical records and analyzed it word by word.
The cerebrospinal fluid IgG oligoclonal band test was positive for type 3 - often indicating acute myelitis, which is one of the signs of multiple sclerosis.
There are consistent extra bands in the blood and cerebrospinal fluid - a sign of systemic inflammatory response.
...
The test results one by one turned into countless diagnostic criteria in front of Xu Qiu, and all related diseases immediately jumped out and were ruled out by Xu Qiu one by one.
On the desk, there were braised spareribs sent by Liu Susu, sour plum soup sent by Yunmei, tiger skin chili peppers sent by Chen Jia, and soft-boiled eggs, boiled eggs, fried eggs, and egg fried rice sent by Li Xue, Qin Qiyin, etc., all of which were already gone.
In the afternoon, before going to work, Xu Qiu's pupils suddenly shrank, and his body immediately leaned forward 45.3 degrees, staring closely at a line of records on the medical record.
"Positive MRZR reaction in cerebrospinal fluid"
Xu Qiu was stunned.
MRZR reaction, the full name of which is measles-rubella-zoster antibody intrathecal reaction.
This is actually one of the indicators for diagnosing multiple sclerosis.
As we all know, most patients with multiple sclerosis will show oligoclonal bands in cerebrospinal fluid, which has always been a classic biomarker for the diagnosis of multiple sclerosis.
As a rare disease, multiple sclerosis is very difficult to diagnose.
Therefore, many patients have clinical symptoms similar to multiple sclerosis but do not meet certain diagnostic criteria. Such patients are often referred to as clinically isolated syndrome.
Simply put, if it is multiple sclerosis, but the examination is not complete, then a transitional state is taken, that is, clinically isolated syndrome.
And MRZR was born in this context.
Compared with oligoclonal bands, MRZR has unique advantages in diagnosing multiple sclerosis and the progression from clinically isolated syndrome to multiple sclerosis.
It not only has extremely high specificity, but also because the immune response it produces is mainly mediated by B cells, it can provide guidance for the selection of appropriate immunomodulators.
It can both diagnose and assist in treatment, killing two birds with one stone!
Multiple tests are positive, plus MRZR is positive, so Xiao Liu first suspected multiple sclerosis.
However, subsequent targeted treatment has shown that this is not the correct answer.
It is also because of this that the test result of MRZR positive was glanced into the corner and no one paid attention to it anymore.
However, just after noticing this test indicator, Xu Qiu had a bold idea in his mind!
Maybe he knew the answer!
...
Soon after, Fan Fuguo's EEG test results were sent.
Xu Qiu took it quickly.
The patient's EEG showed obvious abnormalities, showing diffuse, bilaterally synchronous, and periodic high-amplitude biphasic and triphasic delta waves with an interval of 3 to 4 seconds!
In addition, the amplitude increased further in the left temporal occipital area!
Xu Qiu put down the examination list, feeling a sense of optimism.
He might know the final answer...
Gurgle gurgle -
Coming back from deep thinking, Xu Qiu finally felt hungry.
At the same time, the fatigue brought by the morning clinic and the case discussion at noon also hit him deeply.
However, Xu Qiu didn't care about these and dared to hold an emergency meeting again in the last half hour before work.
Joseph, Director Shen, Director Lin, and Director Huo who didn't have time to leave were all here.
They looked shocked and expectant.
They just finished the consultation and suddenly held a meeting again. Xu Qiu must have an idea!
They felt incredible.
It was only noon...
In the time of eating a meal, the patient who had no clue in the morning actually had a clue?
"Doctor Xu, how should we cooperate next?"
"What is the disease and what tests should be done!"
"It's not multiple sclerosis, it's not Creutzfeldt-Jakob disease, the only thing worth discussing is brain disease... Viral PCR did not find any virus, but the pathological results showed brain disease, it's too weird!"
Yang Yuen stared at Xu Qiu with starry eyes: "I said it's useless to go to Berry Country, in the end you still have to look at idols!"
Joseph's face was dark, and he was also very surprised.
"Doctor Xu, what is it?" He couldn't help his curiosity and asked.
Several foreign famous doctors were also moved.
International famous doctors who can condescend to a small foreign hospital for further study just to master a new technology are all old pedants who regard academic and medical careers as more important than anything else.
A patient with almost no solution is placed in front of them, and the final answer is full of temptation.
If Xu Qiu concludes that this is a new disease that has not been included, they will be disappointed.
This feeling is like playing hide-and-seek in a room, and everyone tries their best to find where the last person is hiding.
If they find the cause of the disease by unraveling the mystery, it is equivalent to finding this person in the most hidden corner, and they will be full of a sense of accomplishment.
If it is a new disease, it is like a hider flying thousands of kilometers away, which will make people feel fooled and not following the rules of the game.
They don’t care whether they can discover a new disease, name a disease, and record it in history.
They just want to know where their clinical thinking went wrong in this patient, so that they used all the existing tests, but ended up with viral encephalitis.
