Chapter 894 The truth! The cause of sudden blindness!

Shi Lian also sat on the small stool, with an expectant expression on his face.

Facing the sweet girl and the queen, Xu Qiu's heart was not the slightest bit volatile.

He left the simulated operating room with a little impatience, turned out Pang Honggu's medical records, and said: "Look for yourself, which items should not be normal but have become normal."

After that, he turned on the computer and looked through the literature related to the autoimmune brain.

Some popular common sense, he already knew it clearly.

What he is looking at now is what is rarely mentioned in the academic world.

Or some rare cases.

Medicine is an empirical science after all. No matter how strong your ability is or how high your talent is, it can't beat "having encountered it before".

Learning from the diagnosis and treatment experience of doctors all over the world is the fastest way to brush up experience points.

On the other side, seeing that they were ignored again, Shi Lian and Chen Qiao both frowned.

The two had to fend for themselves.

"What shouldn't be normal became normal?"

"In other words, the problem lies in the seemingly normal examination items?"

Shi Lian and Chen Qiao's abilities are still outstanding.

In a few minutes, the two of them locked their sights on "normal heart rate".

Pang Honggu was in a state of bradycardia when she was admitted to the hospital and before, but after several subsequent electrocardiograms, her heart rate returned to normal.

The patient had long-term bradycardia before coming to the doctor, how could she suddenly get better!

"See what treatment was done when the heart rate changed!" Chen Qiao urged.

Shi Lian flipped through the pages quickly, and said, "I know, I know, senior sister, don't rush me."

"You're so slow, can you be more agile?"

"..."

Shi Lian chose to ignore the senior sister's venomous snake, and finally turned to the first page where the heart rate returned to normal.

This was the second day the patient was admitted to the hospital.

Compared with treatment, Pang Honggu mainly conducted various examinations.

Including CT scan of the sacrum and coccyx, as well as conventional ultrasound, etc.

If you insist on talking about treatment, it is that she took metoclopramide, the purpose of which is to treat acute gastroenteritis.

"Is this the reason... The main active ingredient of Metoclopramide is metoclopramide... What are the side effects of metoclopramide?"

Shi Lian seemed to have thought of something.

She quickly took out her phone and searched for metoclopramide.

Not everyone is Xu Qiu. Doctors are also human beings. It is impossible for them to know the drug interactions, pharmacology and toxicology of each drug.

But Chen Qiao's actions were faster. Her eyes lit up and she pointed to one of them.

"Large doses or long-term use may block dopamine receptors, leading to relative hyperactivity of cholinergic receptors, thereby causing extrapyramidal reactions!"

The two exclaimed almost in unison: "It's an extrapyramidal reaction!"

The extrapyramidal system is an important part of the human motor system. Its main function is to regulate muscle tension and control the coordinated movement and balance of muscles.

The core of the regulatory role lies in the dynamic balance of the central neurotransmitters dopamine and acetylcholine.

When taking metoclopramide, the body's dopamine may decrease, and the relative acetylcholine will increase, resulting in increased muscle tension, faster heart rate, obstacles in motor coordination and balance, and oral-tongue-cheek triad.

Visual impairment is one of the side effects!

However, Pang Honggu was unable to get out of bed due to physical reasons, so the doctor could not immediately discover her loss of motor and balance abilities.

Therefore, sudden blindness became the only clue, and it almost caused misleading...

"It turned out to be like this!" Shi Lian suddenly realized.

The side effects caused the heart rate to increase, but it brought the bradycardia patient to normal values.

Just like left heart failure.

In the late stage of left heart failure, the patient suddenly had no symptoms, no cough or wheezing.

If it is an inexperienced person, he may think that his medical skills are excellent and the patient is getting better.

In fact, it is because the right heart has been bearing the severe load brought by left heart failure for a long time, and finally it can't hold on, and then pulmonary circulation hypertension also occurs, and it develops into right heart failure.

The original cough and wheezing are the manifestations of right heart compensation, which means that it can still be saved.

But when the cough and wheeze disappear, the patient officially enters the era of total heart failure, and is not far from death.

The late stage of left heart failure develops into total heart failure, which looks normal, but is actually terminally ill.

Pang Honggu is similar. Her heart rate looks normal, but it is actually another pathological state caused by a negative plus a negative.

"It's good, it's good..." Chen Qiao patted her chest.

The teacher's diagnostic ability is still unique.

There is no comparison!

"Teacher, what about the suddenly increased anti-NMDAR receptors..." Shi Lian frowned again.

There is no need to worry about sudden blindness, but there are immune indicators that have risen again.

"I'm still thinking about it." Xu Qiu shook his head.

He couldn't give a direct answer.

When he examined Pang Honggu just now, he had been thinking about this, but in the end he didn't find anything.

Xu Qiu reopened the medical record interface.

The latest examination report is a gastroscopy.

He tried to find hair in the patient's stomach and make inferences based on this, but failed.

No hair tissue was found in the gastroscopy.

Xu Qiu took a deep breath, closed his eyes, and sorted out the patient's condition.

First, the frequent cardiac arrest.

This is also the reason why Pang Honggu was sent to the ICU.

Second, the anti-NMDAR antibodies were abnormally elevated, and suddenly recurred after the plasma exchange was effective.

Suspected anti-NMDAR encephalitis, also known as primary autoimmune encephalitis.

However, if it is primary autoimmune encephalitis, the antibody index should turn negative after plasma exchange treatment, and generally will not suddenly turn positive again!

The most likely reason is that the patient is not primary autoimmune encephalitis at all.

Anti-NMDAR positivity is not the cause, but an indirect change caused by the real culprit!

The last one is the hair in the vomit.

It is not yet certain where these hairs come from.

It is possible that the patient swallowed it from the mouth. Although the probability is low, it is not impossible.

After all, there is no surveillance in the ward, and no one knows what the patient did in it.

What if the family collected it from the barber shop and fed it to the patient?

Although this conjecture is more vicious, there are a lot of darker things in clinical practice.

It cannot be prevented.

Another possibility is from the body.

The first thing that can make the body produce hair is teratoma.

This is a tumor derived from germ cells, which mostly occurs in children and women of childbearing age. Women after menopause also have it, but it is rare.

Since the root of teratoma is in the germ cells, its morphology is extremely variable. Hair, teeth, oil, and even various flesh and blood tissues similar to the fetus may develop in the teratoma.

This disease is not very rare.

But it must be one of the most physically uncomfortable diseases.

After all, the reason why teratoma is called this name is related to its certain similarity with "deformed fetus".

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