Chapter 892 Sudden blindness, death threat!
Xu Qiu looked a little strange.
This is a regular tertiary hospital, not an operating room in a sewage country.avi.
"Did you check the vomit of Pang Honggu last week?" Xu Qiu asked indifferently.
Shi Lian quickly got into work mode, tapped his chin with his index finger, thought for a while, and nodded: "Yes."
The job of a clinical doctor is part-time treatment, excrement removal, vomiting and other work.
Even Xu Qiu would check the patient's vomit from time to time, let alone Shi Lian.
"Let me think... It seems that there is hair. I suspect it is pica. I did an iron deficiency anemia test, but nothing was found. Later, pica was ruled out." Shi Lian explained.
"Where did the hair come from?"
"The family said that the patient's mental state has not been very good. In the past few months, the patient has been a little crazy. Sometimes she eats the wrong things. Maybe she accidentally ate hair."
"Too far-fetched."
Xu Qiu shook his head slowly.
This inference seems reasonable, but there is no substantial evidence.
He asked again: "Has the sample been preserved?"
Shi Lian was surprised: "No, how could it be preserved for so long... But teacher, I took a photo, a close-up photo!"
Xu Qiu pointed at the desk.
Shi Lian immediately trotted over, opened the album on his phone, and put the screen close to Xu Qiu.
Although they had just finished their meal, the two of them didn't feel anything special when they saw the vomit.
A small group of black threads were entangled together, covering the chyme. If you don't look carefully, you might think it was undigested bean dregs.
Shi Lian wrinkled his nose and said: "It stinks, a smell of fermented broth. I wore several layers of masks before I dared to check it."
Xu Qiu was not interested in this. He enlarged the picture and looked carefully at the picture in the vomit.
Soon he frowned.
Something is wrong.
This hair doesn't look like it's on an old man's head.
First of all, the lengths are different and the thickness is uneven.
Even the depth of the color is different.
Some are as long as a finger, showing a dark black color, while others are shorter, about the length of a knuckle, and the color is also lighter.
They are called hair, but they are more like broken hair.
Pang Honggu has short hair. Due to genetic reasons, she does not have many white hairs on her head. If you insist that these hairs are all hers, it can barely make sense.
But...
The more Xu Qiu looked at it, the more he felt that these hairs did not fall from the same person.
Instead, they looked more like hairs in different developmental stages.
For example, the hair of a three-year-old child, the hair of a ten-year-old boy, and the hair of a twenty-year-old young man...
Could it be that Pang Honggu secretly ran to other wards in the middle of the night to eat hair?
Since the incident of professional players soliciting customers in the inpatient department and showing their ventriloquism a few years ago, the corridors of the clinical hospital have been full of surveillance cameras, and the people at the nurses' desk and the monitoring room are not just eating for free.
Pang Honggu is not easy to move, and it is even more ridiculous to want to avoid eyes.
"Hiss, it's a bit scary..." Shi Lian was a little scared.
Xu Qiu glanced at her.
You are a woman who opened her chest and grabbed her heart and muttered that it was not as big as a cow's heart and was not enough to cook two dishes. Why are you afraid of this?
"Let's do a gastroscopy first to determine whether there is any hair in the patient's gastrointestinal tract." Xu Qiu had a few guesses, but there was no evidence.
The best way is to do another examination.
The patient vomited because of acute gastroenteritis, but the hair should not be related to this now.
If the gastroscopy can find hair, it is worth thinking about.
However, these are not the main points.
The key at the moment is to treat autoimmune encephalitis!
The anti-glutamate receptor titer in the patient's body is too high, and conventional treatment methods may not work. Only plasma exchange can be done.
In addition, glucocorticoid methylprednisolone and immunoglobulin are added.
This is the first-line drug for the clinical treatment of autoimmune encephalitis.
Shi Lian quickly wrote it down.
Xu Qiu pondered again.
The treatment of autoimmune encephalitis is not troublesome. There are a lot of ready-made drugs and treatment measures, which is not a problem for him.
But... what about the cause?
Why did the patient suddenly have autoimmune encephalitis?
"Isn't it because of abnormal glutamate receptors... Abnormal increase in antibodies." Shi Lian blurted out.
Xu Qiu continued to ask: "Why does the anti-glutamate receptor antibody increase?"
"Because... because..." Shi Lian was stuck.
Among the causes of autoimmune encephalitis, the pathogenesis of most patients is simply anti-neural antibodies. As for going deeper, the academic community has not reached a conclusion.
Clinicians will not delve into it.
If it is confirmed to be anti-NMDAR encephalitis, symptomatic treatment will be the end of it.
Shi Lian was stunned by Xu Qiu's question.
Out of inertia of thinking, she did not think deeply about the cause of anti-glutamate receptors...
Xu Qiu waved his hand and said: "Let's do plasma exchange first. If the concentration of anti-amino acid receptor antibodies decreases and does not recur, it should be primary anti-NMDAR encephalitis."
Among the causes, primary anti-NMDAR encephalitis is the simplest.
But in addition to this, there are many diseases that can induce autoimmune encephalitis, which can also lead to positive anti-NMDAR antibodies.
For example, tumors and infections.
Some patients with anti-GABAbR antibody-related limbic encephalitis combined with small cell lung cancer or herpes simplex can cause anti-NMDAR encephalitis.
I hope it is primary...
...
...
The patient started plasma exchange treatment that day.
The emergency department and the neurology department were all nervous. After all, Xu Qiu paid special attention to the doctor. Although Xu Qiu was very strong, he always felt that the patients in his hands should not get better so quickly...
Otherwise, it would be a bit sorry for Xu Qiu's medical skills.
However, the patient did not seem to be an exception.
Her anti-glutamate receptor antibodies were constantly decreasing and gradually approaching normal values. Her mental state was also improving at a visible speed. It would not take long for her to get along with her family and medical staff in the ward.
But at this time, the nursing department suddenly reported a bad news!
The patient could not see...
"Blind?"
Xu Qiu was a little surprised when he got the news.
He did not encounter many patients with sudden blindness, but every one of them was a very serious disease.
For example, Luo Di was found to be a brain-eating worm, and he survived after losing half his life.
There are several more behind, either various brain tumors or rare diseases that are difficult to diagnose and incurable.
Before this, Pang Honggu's condition was not good, but autoimmune encephalitis was at least a relatively common disease, and the clinical guidelines were also very clear. Just take medicine according to the treatment principles.
But a sudden blindness made her risk factor soar!
Xu Qiu got up, he had to go to see the situation quickly.
However, before he could get there, the emergency call suddenly rang again.
"Oh no, Dr. Xu, the patient's anti-NMADR antibodies suddenly soared!"
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