Rebirth of Medicine Practices the World

"Second, the patient's eyeballs are basically fixed in the center, and the up, down, left, and right movements of the eyeballs are limited. This sign can explain why the patient cannot see clearly what is beyond the front."

"The patient's pupils are relatively small, the light reflex is present, the convergence reflex is impaired, and the doll'seyes sign is obvious. Dr. Zhang should have seen it just now."

"Well, well, it is indeed very typical." Zhang Yin quickly replied. Zhang Yin had only seen such physical signs in books. This was the first time she saw it on a patient. She was excited, excited, and also very shocked: "

Why didn’t we pay attention to this sign?”

"Looking further down, the patient's gag reflex is good, the soft palate movement is good, the mandibular reflex is very active, and the palmomandibular reflex is also positive. I will explain why this is happening in a moment."

"In terms of limbs and trunk, the patient's head and neck muscle tension is particularly high, and it is difficult to turn the head. The muscle tension of the limbs also increases in a "lead pipe-like" manner (a feeling when bending a lead pipe with force), but it increases

It’s not obvious. This is quite obviously different from patients with Parkinson’s disease.”

Lin Lin was like peeling an onion, layer by layer. The more everyone listened, the more excited and confused they became. They all felt that Lin Lin was amazing and could detect so many typical physical signs.

They were also curious, which disease did these signs point to?

It was very quiet in the office. Apart from the sound of the photographer's gentle footsteps, the only sound left was Lin Lin's deep bass.

"At the same time, the patient's pyramidal tract signs are obvious, the tendon reflexes of the limbs are very active, and the pathological signs are positive. This is extremely rare in patients with Parkinson's disease."

"Also, the strong grip reflex of the patient's hands is positive. This sign is also very directional. I believe everyone sitting here understands which part of the damage this sign points to."

"Okay, the above are the findings of the physical examination. Next, let's take a look at all the examinations after admission to see if there are any special findings." Lin Lin knew that this was equivalent to teaching rounds, so the tone she used was guiding.

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"After the patient was admitted to the hospital, there were no abnormalities in the blood biochemical tests, and there were no abnormalities in the three major routine tests. Let's take a look at the patient's imaging tests."

"After the patient was admitted to the hospital, he had a head MRI examination. I read the MRI report. They issued a report of mild cerebral atrophy. I feel that this report is a bit more general. Come, let's take a look at the patient's head.

Magnetic resonance imaging performance."

Lin Lin picked up a pen and pointed at the MRI photo of her head on the reading light beside her.

"This patient does have brain atrophy, but the distribution of this patient's brain atrophy is very characteristic. As you can see, this is the frontal lobe. Compared with other brain lobes, the atrophy of the frontal lobe is more obvious."

"Well, everyone, look at this place. This is the back of the third ventricle. Is it larger than that of a normal person?" After listening, everyone nodded frequently.

"Why do I say it? In fact, the enlargement of the posterior part of the third ventricle means the atrophy of the patient's midbrain and pons. Why don't I just say atrophy of the midbrain and pons? Because the report did not mention this.

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"The atrophy of the midbrain and pons is indirectly reflected by the enlargement of the posterior part of the third ventricle. This is very important for us to interpret the patient's signs."

"Awesome, so awesome." Han Bin couldn't help but say. All the doctors' eyes, especially Zhang Yin's eyes, shone with a strange light.

"Okay, having said that, let me talk about the localization and diagnosis of this patient, that is, what part of the brain is damaged by the patient's disease." Because Mr. Zhou was listening, Lin Lin tried her best to speak as plainly as possible.

"Everyone has just heard me talk about so many symptoms and signs, and has also seen the changes in the brain's magnetic resonance imaging. You must have understood that the damage to this patient is limited to the brain, but the damage points are relatively scattered."

"Damage to the frontal lobe causes the patient to have intellectual disability, memory decline, personality changes, and a positive strong grip reflex. Therefore, the patient has frontal lobe damage, which is supported by both symptoms and signs, as well as imaging findings.

support."

"Atrophy of the midbrain and pons can explain the patient's eye movement disorder, the patient's pseudobulbar palsy, and the patient's positive pyramidal tract sign."

"There is another damage that we cannot see but may exist, which is the red nucleus-substantia nigra-locus coeruleus system near the midbrain. This system is closely related to the secretion of dopamine. The patient's head, neck and trunk have increased muscle tone.

"Whether it is related to these, I can only speculate based on the patient's symptoms and signs."

"Okay, let me summarize it. This patient's diagnosis is damage to multiple parts of the brain and multiple systems."

"As for the qualitative diagnosis, I believe that this patient suffers from a very rare neurological disease called progressive supranuclear palsy, abbreviated as S in English."

"The characteristic of this disease is that the age of onset is generally between 51 and 60 years old, and it is more common in men. If two of the following five criteria are met, the diagnosis can be made."

"These 5 criteria include, 1. Symmetrical akinesia or rigidity, with the proximal end heavier than the distal end; 2. Pseudobulbar palsy (dysarthria and dysphagia, but normal gag reflex); 3. Neck ***

Abnormalities, especially the neck being tilted back; 4. Frontal lobe syndrome (mental retardation, strong grasping and groping movements); 5. Poor response to levodopa treatment, or unresponsive Rknson syndrome."

"According to this standard, this patient completely meets the criteria. Therefore, my qualitative diagnosis of this patient is S."

"The cause of this disease is still unclear. Some people say it is related to lentivirus, such as CJD-like diseases, but I do not agree with this statement."

"For the next step of examination, it is recommended to do a dynamic electroencephalogram to see if there is diffuse, non-specific slow wave activity, which is also one of the characteristics of this disease."

"In addition, if Mr. Zhou agrees, you can do a lumbar puncture to collect cerebrospinal fluid for examination. About one-third of these patients have high cerebrospinal fluid protein."

"As for treatment, so far, there is no special treatment method in the world. Treatment methods for Parkinson's disease can be considered, but the efficacy is generally not good."

"This is my analysis of this patient. It may not be correct. Please correct me." When Lin Lin said this, she quickly stopped.

As soon as Lin Lin finished speaking, there was a burst of dense and deep applause. The applause was also mixed with cheers. It was obvious that everyone was conquered by Lin Lin's wonderful analysis.