The case comes from the Department of Neurology of the Second Central Hospital. The patient's surname is Chen, a man, and he is only 18 years old.

"This is my cousin." Chen Xi introduced, "He has always been in good health before and has never heard of any problems."

"And then I suddenly had epilepsy?" Sun Lien quickly browsed the case brought by Chen Xi. "The MRI scan prompted that there was an abnormal signal on the right rated junction area, and the symptoms were like epilepsy." He put down the case, "There is no problem with this."

"The problem is that there is no problem with this." Chen Xi sighed, "The second hospital diagnosed it as symptomatic epilepsy. My medical records were like epilepsy, but the second hospital gave phenobarbital, levetiracetam and mannitol for treatment. However, the condition did not improve at all, but it began to become worse."

"What does it mean to be serious? The frequency of epilepsy has become higher?" Xu Yourong became a little interested when he heard this. "Are they going to have an epilepsy longer?"

"During the treatment process, there were three symptoms of numbness and weakness in the left upper limbs, and then the limbs were convulsed and lost consciousness. It was exactly the same as before the previous epilepsy seizure. Moreover, after waking up, the left upper limb was still numbness and weakness. The area of ​​weakness has extended from the left finger to the proximal end of the forearm." Chen Xi said seriously, "I don't think there is any serious problem with epilepsy multiple seizures, but his upper limbs are numb and spread, so I think something is wrong."

The persistence of the condition indicates that standard treatment did not have an effect on his epilepsy. This may mean that Chen Xi's cousin's epilepsy is more stubborn, and the effect of phenobarbital and levetiracetam is not enough - the medication regimen may need to be adjusted. But the progress of the condition is very wrong, which shows that the problems Chen Xi's cousin's problems are likely to be deeper than epilepsy. Something caused his epilepsy, and the cause of this epilepsy was not affected by phenobarbital, levetiracetam or even mannitol. It is still worsening further.

Xu Yourong came over and looked down at the case in Sun Lien's hands. Sun Lien shifted his focus to the follow-up diagnosis plan of the Second Hospital.

"Are they suspected of being poisoned?" Sun Lien thought to himself as he looked at the latest test reports in the case. The suspicion of the Second Hospital is indeed in one direction. The numbness and weakness that extends upward from the end of the limb is indeed similar to some brain nerve damage caused by certain poisoning symptoms. In addition, the case of Zhan Hao, the brother of Zhan Jun, who was previously regarded as simply demyelinating and did not undergo follow-up examinations, Sun Lien has enough reason to believe that the genius doctors in the Second Hospital were hung up by the director and whipped it with a whip.

Otherwise, how could he suspect poisoning first? This symptom is obviously wrong! Sun Lien complained in his heart that after leaving the poisoning environment, the symptoms of poisoning should improve. At that time, Zhan Hao's condition recurred because he ingested the second time he ingested the bacon containing lead. Any poisoning symptoms should at least relieve or stop progress after leaving the poisoning environment. Where did he worsen after leaving the poisoning environment?

If it is not poisoning, what disease can cause epilepsy, and phenobarbital and levetiracetam are ineffective?

The reasoning came to an abrupt end. Sun Lien was frustrated and found that he did not have the ability to continue reasoning. As an emergency doctor, he was not very familiar with these two drugs. This was especially true when analyzing the mechanism of action. In fact, it is inevitable that there are only hundreds or thousands of drugs used in the hospital. Except for the old thing, Sun Lien suspected that there were no doctors in the entire Song'an Province and even the whole country who could memorize all the mechanisms of action of drugs.

"I think the direction of the poisoning may be a little problem." Sun Lien and Xu Yourong exchanged a few words, and then said to Chen Xi who was a little anxious, "The Second Hospital may be a little too concerned about the previous mistake..." In fact, Sun Lien himself did not believe this. It is rare for a Grade A hospital such as the second hospital to specifically emphasize the diagnosis plan because of a separate case. What's more, the attending doctor who treated Chen Xi was the one who treated Zhan Hao before, Zhan Hao's severe lead poisoning could actually pass under the nose of the doctor in Shen's nose, and even almost cause a medical accident. This would inevitably cause a serious psychological shadow on the doctor.

"What should I do? Brother Sun, can you accept it?" Chen Xi showed his true intention. The main purpose of his visit was that he actually wanted his cousin to come to the diagnosis center for treatment. "The water products from the Second Hospital... to be honest, I'm not very relieved."

The second hospital's level is actually quite good. Although Sun Lien really wanted to say that, he was really not easy to say when he saw that the two cases in the second hospital fell into his hands.

"I think this case can be accepted." Xu Yourong, who was in charge of the preliminary review, simply took the case from Sun Lien and started reading in detail. A few minutes later, she gave her own opinions, "This progressive, unknown cause of divine diseases has the value of intervention. The Second Hospital has a slightly worse ability to deal with this type of disease."

The translation is "This disease may be very dangerous, but I can't believe in the level of the Second Hospital." Sun Lien nodded, and Xu Yourong said so, it seems that it does have the value of the next level.

"Okay, please contact the hospital there." Sun Lien nodded. He was also very curious about this patient. Of course, more importantly, he also wanted to know what the origin of epilepsy, which is ineffective in both phenobarbital and levetiracetam. "Can you transfer it today?"

"No problem." Chen Xi was overjoyed. He had heard other seniors and teachers complain about the department's seniors and teachers. The patients in the diagnosis center had very high standards for acceptance. He had not had much expectations for transferring to the diagnosis center for treatment. He came here with the case just to see if Sun Lien had any other opinions on his cousin's condition. Unexpectedly, the transfer was really completed. "I'll contact you now, and I'll have someone come here before noon today!"

"Then you go and go through the procedures first." Sun Lien nodded and pointed to the case in Xu Yourong's hand. "We will copy this case. When the patient comes, we will take all the latest examination reports from the Second Hospital and other things." The Shenwen level in the Second Hospital may not be very high, but the level of the laboratory department is still quite good. Holding the ready-made test report, even if no abnormalities are found, at least it can help Sun Lien and others eliminate some problems as soon as possible in their subsequent diagnosis.

After Chen Xi left, Bruen also came over. He couldn't quite understand Chinese, but it was not a big problem to listen to Xu Yourong's retelling. After listening to the general content, he rubbed his chin thoughtfully, "This symptom description sounds like glove-like numbness."

"Do you suspect acute demyelination? The progress is a bit slow." Xu Yourong is not very optimistic about this opinion. "Glove-like numbness is usually symmetrical on both sides, and when the disease occurs, the whole hand is already numb, and his progress is not very similar."

Sun Lien also gathered together to make fun of it. "Many patients with glove-like numbness come when they see the doctor when they see the doctor. The main reason for this patient's admission is epilepsy - the symptoms of epilepsy are more obvious. Could it be because of this? They were admitted to the hospital first and then they found the progressive glove-like numbness?"

"It's a bit far-fetched, but it's a bit off." Xu Yourong nodded, "Do you think the reason for his glove-like numbness is directly related to epilepsy?"

"Don't you think so?" Sun Lien widened his eyes, "I thought you recognized this and asked someone to be transferred to the hospital."

Xu Yourong shook his head, "You think epilepsy occurs because of numbness on the left limb. I suspect there is a more fundamental reason that causes epilepsy and limb numbness at the same time." This explanation is a bit difficult to say, but Sun Lien still understood what Xu Yourong meant - epilepsy is a manifestation of abnormal discharge in some areas of the brain. Xu Yourong felt that some disease caused abnormal discharge, and progressed to numbness on one side of the patient's limb. Sun Lien's judgment was that limb numbness and brain discharge abnormality are actually abnormalities in the same area. Both inferences can be valid under existing evidence, but the diagnostic directions and ideas led by the two inferences are very different.
Chapter completed!