Rebirth of Medicine Practices the World

"The patient has no history of hypertension, diabetes, or similar attacks. He has a history of chronic bronchitis, which attacks more frequently in autumn and winter every year. He has no history of smoking or alcohol abuse."

"On physical examination after admission, the vital signs were stable, the cardiopulmonary examination showed no abnormalities, and there were no dry or moist rales in both lungs. The abdomen was soft, with no tenderness or rebound tenderness."

"Nervous system examination revealed that the patient had unclear articulation, a slightly hoarse voice, and coughed when drinking water. The eyeball movement was normal, no nystagmus was found, the soft palate movement was slightly poor, and the gag reflex was slightly poor. Other cranial nerve examinations found no abnormalities.

.”

"The muscle tone of the limbs is normal, the muscle strength of the limbs is weak level 4, the tendon reflexes are symmetrical and normal, and no case reflex is elicited. Sensory examination shows that the patient's pain and temperature sensations are normal."

"After admission, low-molecular-weight dextran was administered intravenously and low-flow oxygen was administered. At present, the patient's condition is stable. My report is completed."

Ding Feng's professionalism has always been recognized and admired by Lin Lin. Her report was detailed when it should be, and simple when it should be, but she did not miss any important link.

"The report just given by Dr. Ding was very detailed, and the treatment was timely, including examination and medication. At present, the patient's diagnosis is not clear yet. Please give your opinion." Faced with Ding Feng's almost perfect report, Ling Xiaoyun really couldn't find it.

Go to a place where she can show off her power.

"Aside from chronic bronchitis, this patient has no bad habits and no underlying diseases, such as high blood pressure, diabetes, etc."

"Judging from the patient's onset pattern, the patient's lesions should be mainly located in the blood vessels of the posterior circulation of the brain. Since CT did not find any lesions, I am more inclined to diagnose TIA (transient ischemic attack)." Li Yun'e said about her own disease.

I am very confident in my judgment and speak first.

"I also agree with Teacher Li's diagnosis. However, the patient still has some suspicious signs and needs to continue to be observed. If the patient's signs disappear soon, the diagnosis will be established." Ding Feng also prefers the diagnosis of TIA.

Faced with this situation, other doctors chose to remain silent.

"Dr. Lin, what's your opinion?" Ling Xiaoyun knew that Yu Zhitong was very concerned about Lin Lin's opinion.

"Okay, let me tell you my opinion."

"Although I have not performed a physical examination on the patient, I believe that Dr. Ding's physical examination results are accurate."

"From the patient's way of onset, time of onset, symptoms and signs that appeared after the onset, and the findings of the head CT examination, I also agree that the patient's illness this time is mainly caused by lesions in the posterior circulation of the brain."

"If I'm more specific, I think the patient's damage is mainly to the medulla oblongata and lower pons. However, I don't agree with the diagnosis of TIA in this patient. I think the patient's diagnosis should be incomplete in the dorsolateral medulla.

Syndrome' is caused by blockage of individual branches of the posterior inferior cerebellar artery."

"The reason why I made this diagnosis is that the patient currently has physical signs to support it, such as worsening of soft palate movement, worsening of gag reflex, choking on drinking water, hoarseness when speaking, lack of articulation, and decreased muscle strength of limbs."

"It is said to be incomplete 'dorsolateral medulla syndrome' because some signs have not been discovered yet, or are not typical yet. For example, signs of cerebellar damage, imaging changes of cerebellar damage, and muscle strength decline should be treated as normal.

The side is the main one and so on.”

"This is the localized diagnosis of this patient. As for the qualitative diagnosis, there should be no suspense. It must be an ischemic injury. Because the diagnostic rate of CT for cerebral hemorrhage reaches more than 99%."

"Let me explain again why the patient's head CT did not show any lesions. I think there are three possibilities."

"First, at the time of the examination, it was only 4 hours before the patient's onset of illness. We know that whether it is an infarction in the cerebral hemisphere, cerebellum or brainstem, within 24 hours after the onset, especially within 12 hours, the lesions are different from the normal ones.

The brain tissue is in the 'isodense phase', and at this time, it is not easy to detect lesions with CT scan."

"Second, the location of the lesion is just in the posterior fossa of the brain. We know that there are many bone protrusions in the posterior cranial fossa of the brain. These protruding bones can easily produce artifacts during CT examinations. These protrusions are

Artifacts will cause the observation of the brainstem, cerebellum and other parts of the body, and even cover up the lesions. Therefore, if the lesions cannot be seen in these places, it does not mean that there are no lesions."

"Third, at present, the patient's physical signs are not obvious. It cannot be ruled out that the patient's lesions are relatively small, as small as less than 1 cm. Because, during the CT scan, each layer is exactly 1 cm apart. If the lesions are smaller than 1 cm, it is possible

Not detected by CT."

"Now, let me focus on what we need to pay attention to in diagnosis, treatment and disease observation."

"First, the patient is still in the acute stage, and the current signs do not mean that the signs will remain unchanged in the next few hours or days."

"The peak period of edema after cerebral infarction may not arrive until 2 weeks after onset in individual patients. If this is the case, the patient's condition may continue to worsen."

"Therefore, we must closely observe changes in the patient's speech and consciousness, limb muscle strength, and changes in swallowing. These conditions may be aggravated, and some new signs may even appear, such as signs of cerebellar damage."

"Second, since I judge that it is an incomplete 'dorsolateral bulbar syndrome', it is necessary to prevent the patient from accidentally inhaling food or liquid into the lungs when eating and drinking. Once this happens, it will be very serious.

dangerous."

"So, I suggest that the diet at this stage should be mainly semi-liquid, such as paste food, and try not to feed water directly to the patient."

"It is necessary to closely observe the patient's body temperature, blood count, and rales in the lungs. Once the possibility of aspiration pneumonia is discovered, it should be checked and dealt with promptly."

"Actually, what I am most worried about now is not cerebral infarction, but aspiration pneumonia caused by cerebral infarction damaging the swallowing function. Because the process of cerebral infarction is irreversible, and for this patient, it is not

deadly."

"This patient has a history of chronic bronchitis. Once aspiration pneumonia occurs, it will be very troublesome and difficult to treat. Therefore, aspiration pneumonia is what we need to focus on preventing."

"Of course, we must attach great importance to preventing the recurrence or aggravation of the primary disease. In this regard, Dr. Ding has done a good job."

"In terms of nursing care, it is necessary to turn over frequently, pat the back frequently, and suction sputum in time. Prevention of complications and ensuring nutrition must be carried out simultaneously, and both are indispensable."