Chapter 510 The truth about the disease! False fever!

“Aren’t the 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 awe 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 quickly started the consultation without talking nonsense.

"What, not chills?"

"Fever isn't really fever?"

Director Shen and others looked at each other.

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 did not sell the matter, but directly pointed out the key points: "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 mind also find it a bit incredible.

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 seizure.

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. There are mild and inconspicuous muscle twitches in the body. Of course, when focal epilepsy is severe, it may also cause severe muscle twitches.

"Then...how do you explain the 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 several weeks after acute infection or 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, and loss of sensation in the limbs below the level of the lesion, and may even cause paralysis.

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 OK, 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's illness started 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 hesitated.

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

Early bowel obstruction!

The vast majority of patients with transverse myelitis will experience urinary and fecal incontinence in the early stages of the disease. Urinary retention occurs in the early stage, and becomes stress urinary incontinence during the recovery period.

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 the 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, the next step will be 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 a bit too arbitrary. It is safer to do a spinal MR..."

The findings of spinal cord swelling and long T1 and long T2 signals also support Xu Qiu's diagnosis.

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

The other doctors nodded.

They respected Xu Qiu very much.

But when it comes to curing diseases and saving lives, authority and status are not important. In the face of disease, only the wise can be the teacher.

Whoever is right and the diagnosis is reasonable, even an intern can question the chief physician.

Of course, this is limited to hospitals with excellent medical style such as Linyi.

…

“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. The pressure of the cerebrospinal fluid extracted from them was normal, and the appearance was transparent. Only the number of cells was slightly increased, and nothing could be seen at all.”

“It depends on luck to do a cerebrospinal fluid examination. Some patients happen to be in the acute stage of the disease, and it is possible to find spinal canal obstruction, which can confirm the diagnosis.”

“The diagnosis of transverse myelitis depends on the precursor symptoms, onset form, neurological signs and laboratory tests. Now the precursors do not match, and no diagnostic laboratory tests have been done. The neurological signs do not seem to be very consistent... The onset form can barely make sense.”

“Dr. Xu’s diagnosis must be reasonable. We should have overlooked something.”

“Just believe it! Just treat it as acute myelitis!”

Neurologists argued endlessly.

Focused on two issues.

One: How to determine whether the patient started with weakness in the lower limbs and developed and spread upwards;

Two: Why not do MRI for diagnosis?