Rebirth of Medicine Practices the World

"Are you completely healed after your first treatment?"

"It can be said that at least I can control my urination and defecation, and the numbness has disappeared, but the strength of my hands and feet is still not as good as before. Also, since I was hospitalized in Nanjiang Hospital last time, I have been feeling tired and suffering from heart palpitations."

"Is this still the case now?"

"have."

"Did you feel any discomfort before your first attack?"

"Well...I remember, before the onset of the disease, I had a sore throat and fever."

"Oh, you have a fever? Do you remember the highest temperature?"

"I remember that the highest fever at that time was 39.1 degrees. The doctor quickly gave me medicine and my body temperature quickly returned to normal."

"Okay, you lie down on your back and I'll check it for you."

After Lin Lin said that, she started to do the inspection.

This was Huang Rui's first time seeing Lin Lin undergo a physical examination. Huang Rui felt comfortable and deeply impressed by her skillful technique.

After the physical examination, Lin Lin told the patient that the doctor would try his best to find out the cause of the disease and provide targeted follow-up treatment.

Lin Lin washed her hands and returned to the doctor's office to sit down.

"Let's discuss it." Lin Lin wanted to see how the department was doing after Dong Huayu took over.

"I am the doctor in charge. Let me share my opinion first." Zhang Cuicui spoke first.

"The patient is a female who suffers from recurrent episodes of urinary and fecal incontinence, numbness and strength loss in her limbs."

"I saw Dean Lin for a physical examination today and found that the patient had an obvious 'saddle-type' pain-tactile disorder and anal reflex loss."

"At the same time, the patient also has numbness and weakness in the limbs, mainly in the lower limbs, but also in the upper limbs. The patient's pathological signs are relatively contradictory. The tendon reflexes of both lower limbs are weakened, but the Pap sign is positive."

"After the patient was admitted to the hospital, he was very sensitive to hormone treatment, and his symptoms were greatly improved quickly. This was similar to the patient's first attack."

"For the localization and diagnosis of this patient, I consider spinal cord damage as the main cause. Moreover, this damage is relatively scattered, with high-level spinal cord damage and low-level spinal cord damage."

"Among them, based on the medical history and physical examination results that Dean Lin asked today, I believe that the main lesion is between the 2-4 segments of the sacral spinal cord."

"As for the qualitative diagnosis, I still think it is neuromyelitis optica, which is mainly caused by spinal cord damage."

"For the next step of diagnosis, I recommend doing an MRI centered on sacral cord 2-4."

"In terms of treatment, we will continue to maintain the original plan. I have finished my speech. Please correct me."

"I agree with Dr. Zhang's opinion. I must reflect on myself. The patient's 'saddle-type' sensory disorder is so obvious, but we did not detect it."

"It's not that we don't know how to check, but we haven't thought about this problem. I always have a question in my mind. Doesn't sacral spinal cord damage cause constipation and urinary retention? Why does this patient have fecal incontinence?" Liu Yulan admitted to herself.

After the shortcomings, she raised her confusion.

"This is my first ward round with Dean Lin, and I learned a lot from it. For example, how to ask for medical history, how to pay attention to details, and how to conduct a physical examination of the nervous system."

"I used to think that everyone could do physical examination of the nervous system and it was not difficult. Today, when I saw Dean Lin examining a patient, I realized how superficial I am."

"Only with standard and comprehensive techniques can the patient's hidden physical signs be found."

"I completely agree with what Dr. Zhang and Teacher Liu just said. Professionally, there is still a lot for me to learn." Huang Rui's words came from the heart.

"Ever since Director Ding was here, I have discovered that for some questions that we thought were very simple, after Dean Lin's ward rounds, Dean Lin could always dig out many details that we had not noticed."

"With this patient, as Dr. Huang said, we did neglect important details, which made us feel confused and did not dare to discharge the patient easily."

"Actually, I have the same problem as Teacher Liu." Dong Huayu did not analyze further, but followed Liu Yulan to figure out this problem.

"I agree with Director Dong's words. We have witnessed many miracles with Dean Lin. He diagnosed what others could not diagnose. He did what others dared not to treat and cured it."

.”

"A patient like today's seems very simple, but is actually very complicated. I have been practicing medicine for more than 30 years, and I dare not say it accurately because the neuroanatomy and functions of the various parts involved are difficult to understand clearly.

"Ling Xiaoyun did not dare to analyze this patient.

"There are so many interns and training doctors here today, so I will take this opportunity to discuss and learn with you."

"This case is actually a good teaching material for learning the anatomy of the spinal cord and the pathways for bowel and bladder control."

"I very much agree with what Director Ling just said. I can feel Director Ling's caution. This kind of caution is a quality that our doctors must possess."

"There is no shortcut to becoming an excellent neurologist. Everyone must be familiar with and understand neuroanatomy, neurophysiology, neuropathology and the clinical practice of neurological diseases. Whether these knowledge are solid, will

It shows up clinically.”

"All basic knowledge can find its outlet in the clinic. All basic knowledge can provide strong support for clinical practice. Similarly, all clinical problems can provide an ideal entrance for basic research."

"Specifically for this patient, I agree with everyone's positioning diagnosis. Dr. Zhang's speech shows that she has solid basic skills and good logical thinking ability. I hope Dr. Zhang can maintain this style. I am very optimistic about Dr. Zhang's performance."

future."

"Okay, back to this patient. Since the lesions are mainly located in the second to fourth segments of the sacral spinal cord, the examination must be conducted around this segment."

"The low-level center that controls urinary and fecal activities is in the sacral cord 2-4, and the high-level center is in the parietal lobe near the precentral gyrus."

"The issue you just mentioned actually involves an issue I once talked about in my general introduction to neurology, which is the issue of irritating lesions and destructive lesions."

"The high-level center for urinary and fecal control mainly controls people's conscious control of urination and feces. Once this part is damaged, or the conduction bundle below this part is destroyed, the patient will become incontinent."

"Specifically for this patient, it is actually a destructive lesion in the 2-4 segments of the patient's sacral spinal cord."

"The destructive lesions are reflected in the patient's typical 'saddle-type' sensory impairment, which is consistent with the anatomical distribution of damage in this segment."