Rebirth of Medicine Practices the World

"This patient complained of unsteady walking, no dizziness, and no symptoms or signs of cerebellar ataxia. Currently, all the patient's blood tests and imaging tests have found no abnormalities."

"Based on these circumstances, I believe that the patient is diagnosed as 'neurosis', and oryzanol and bus mixture can be considered for treatment. I'm done."

The meaning expressed by Tan Xiaomin was fully demonstrated when he reported the medical history. If Ling Xiaoyun asked him to speak again, he would not say anything new.

After Tan Xiaomin finished speaking, no other doctor took up his topic. There was a silence in the office.

"Let me say a few words." Seeing that everyone was silent, Ding Feng spoke.

"I basically agree with Dr. Tan's analysis just now. I have a question. Generally speaking, most neurotic patients are female. Such patients are more sensitive in character and are very concerned about various discomforts in their bodies.

"

"However, this patient does not seem to have such characteristics. Therefore, I have reservations about this diagnosis, but I cannot give a clear diagnosis." The upright Ding Feng expressed his doubts.

"I also agree with the suspicion raised by Dr. Ding. The patient is male, has a subacute onset, and mainly complains of unsteady walking. This is not consistent with the characteristics of general neurosis."

"Although the current head CT has not found evidence of cerebellar atrophy, I am more inclined to believe that the patient may be in the early stages of primary cerebellar atrophy, and it is worthy of our continued follow-up." Zhuo Guangming's statement is more reasonable, including

Everyone, including Ling Xiaoyun, nodded frequently.

"Let me tell you something." Lin Lin said immediately.

"Wait, Doctor Lin, you'll talk later." Ling Xiaoyun immediately stopped Lin Lin's speech. Ling Xiaoyun was not stupid. She knew that Lin Lin's speech mostly meant the end of the discussion. Because, most people thought of Lin Lin's words.

Speak as your own opinion.

"I agree with Dr. Zhuo's opinion. This patient should continue to be followed up in the outpatient clinic and have regular head CT examinations. As long as more than 5 cerebellar sulci are seen on the head CT, the diagnosis of primary cerebellar atrophy can basically be established.

." This is Li Yun'e, another attending physician in the Department of Neurology. She gave a quantitative index for diagnosing cerebellar atrophy, which shows that she has also put in a lot of effort.

"I also agree with Teacher Zhuo and Teacher Li. This patient cannot be easily diagnosed with neurosis." Liu Yulan knew that she could not escape.

As the director, she can tell from everyone's speech how much effort they have put into this patient. Ling Xiaoyun still has this skill.

"Doctor Lin, tell me. Judging from the way you are ready to act, you must have your own opinions." Ling Xiaoyun always liked to "stab" Lin Lin in public.

Lin Lin smiled slightly and ignored Ling Xiaoyun's words.

"I have a few different views on this patient. Let me tell you and ask the teachers to correct me."

"First, the patient is a male, 56 years old. The onset of the disease a month ago has a tendency of slow progression. Second, the patient's main complaint is unsteadiness in walking. Although a man of this age is not in the best physical condition, he is still strong and powerful.

"

"Third, I conducted a detailed neurological examination on the patient last night and found that the patient had the following clear signs."

"The patient does have unsteady walking, but his walking unsteadiness is very characteristic, that is, when the light is bad, or when he raises his head to walk, the shaking is very obvious. On the contrary, when the patient lowers his head and walks or in good light,

When walking with his head down in the environment, it is difficult to detect that he is unsteady on his feet."

"In addition to unsteady walking, the patient actually has other positive signs of the nervous system. For example, the patient has deep sensory impairments, including tuning fork vibration sense and joint position sense. Also, the patient has difficulty establishing signs with his eyes closed, which is also positive.

."

"In addition, the tendon reflexes of the patient's limbs are active. Although no clear pathological signs are elicited, these pathological signs are at least not negative, but neutral or suspiciously positive."

"Looking closely at the skin of the patient's lower limbs, it appears dry and flaky. This is not what a person with normal neurotrophic performance should have."

Lin Lin's analysis was very clear and organized. Everyone's attention was immediately attracted by Lin Lin's analysis, and everyone listened attentively.

"Let me talk about the patient's laboratory tests again. There is actually a problem with this patient's laboratory tests, and this problem is consistent with my thinking about the patient's diagnosis."

"Oh, you found something wrong with the laboratory test?" Ling Xiaoyun was surprised and interjected.

"Yes, the patient has mild anemia and a decrease in the number of reticulocytes in the blood. These two indicators are not very serious and can be easily missed if you are not careful."

"Based on what I said earlier, this patient's lesions and damaged parts are mainly the posterior cord of the spinal cord. The lateral cords and peripheral nerves are also affected, but it is not very serious. This is my positioning and diagnosis of this patient."

"As for the qualitative diagnosis, in my mind, it is also very clear, that is, subacute combined degeneration of the spinal cord."

"For the next treatment, I recommend that the patient be treated with vitamin b12. Well, I believe that as the treatment progresses, the patient's condition will gradually improve. I have finished my speech."

Lin Lin's speech completely overturned everyone's previous opinions and was well-founded.

"Dr. Lin, I agree with your analysis. However, have you considered that the patient does not have any underlying diseases that cause vitamin B12 deficiency, such as gastric resection, long-term alcoholism, long-term malnutrition, etc. This patient does not have any of these diseases.

." Ling Xiaoyun raised her question.

Lin Lin believes that every doctor here will have such questions. Their knowledge is limited to the questions raised by Ling Xiaoyun, without considering the deeper reasons. In the final analysis, they do not have the profound physiological knowledge like Lin Lin.

He has no foundation in pathology, nor Lin Lin’s meticulous observation and analysis abilities.

"The director is right. The patient has no underlying disease that causes vitamin B12 deficiency. However, we must be clear that these factors only hinder or reduce the absorption of vitamin B12 in food."

"We know that the body's use of vitamin b12 is mainly active b12. In other words, all the vitamin b12 we absorb into the body must be converted into active b12 in the body to be meaningful."