Start as an Emergency Physician

Zhou Yuan's expression also became serious in an instant.

He Jianyi: "The director of the Department of Brain Surgery also did an electroencephalogram and cerebral angiography when he was performing cranial surgery..."

Saying that, He Jianyi stood up and gave Zhou Yuan five or six pieces on the desk, "Take a look for yourself..."

Zhou Yuan took the film and observed.

"EEG... Abnormality of the middle temporal gyrus? Zhou Yuan was stunned.

Duan Hongwei's EEG is dominated by medium-to-high, sustained waves and waves, and is confined to the middle of the temporal lobe, with a clear predominance on the right side of the brain.

Moreover, there is an increase in slow waves on the right side, accompanied by widespread moderate rhythm disorders... This is the EEG manifestation of a patient with cerebral hemorrhage!

"Duan Hongwei had a cerebral hemorrhage when he had an accident?!"

Zhou Yuan's expression was a little complicated.

Once it is confirmed that Duan Hongwei's accident was caused by illness, I am afraid that when the court sentencs and convicts, Duan Hongwei may escape.

Worrying that Duan Hongwei will not be punished by the law is one aspect, and in addition, if these doctors really give a certificate of illness to the heinous Duan Hongwei, those crazy family members will come to find trouble...

Zhou Yuan continued to watch.

An EEG alone won't prove anything.

Cerebral angiography is the key to diagnosis.

"Severe stenosis in the superior portion of the bed process of the bilateral internal carotid artery and the proximal anterior and middle cerebral arteries..."

Zhou Yuan's voice was a little low.

The patient had stenosis of the first segment of the neck of the siphon of the internal carotid artery, and the stenosis continued to the second segment of the neck.

The cerebral angiography on both sides is basically the same, but it is asymmetrical, the stenosis starts from the right side, and there is no vascular stenosis on the left side, the front half of the Willis ring is involved, and most of the perforating arteries at the bottom of the brain, such as the basal ganglia, thalamus, hypothalamus, and brainstem, are also narrowed, and some major cerebral blood vessels form abnormal vascular compensatory collateral circulation at the base of the brain...

At the same time, angiography also showed that there was a significant capillary dilation network at the basal ganglia, forming a collateral circulation centered on the internal and external striatal arteries, thalamic arteries, thalamic geniculate arteries, and anterior and posterior choroidal arteries.

Zhou Yuan frowned.

"It's not just a cerebral hemorrhage..."

He probably had a guess in his heart, looked at He Jianyi again, and said, "Teacher, are there any CT scan images?" "

He Jianyi nodded heavily, handed the table to Zhou Yuan again, and said, "We have the same guess as you..."

Zhou Yuan looked at the CT image.

Duan Hongwei's CT image showed no multiple cerebral infarctions, and no secondary cerebral atrophy...

Generally speaking, the more severe the internal carotid artery stenosis and the worse the blood supply, the more obvious the cerebral atrophy is, but in people with good collateral circulation, cerebral atrophy cannot be seen on CT.

Therefore, collateral circulation is a double-edged sword in medicine, when the main blood vessels are unable to transport blood normally due to thrombosis, stenosis, occlusion, etc., collateral circulation can ensure blood supply through other blood vessels.

But...... Because of the compensatory effect of collateral circulation, it is difficult for ordinary people to find out that there is a problem with their blood vessels, and they do not know that they have a major disease.

"The patient's ventricles are enlarged and accompanied by intracranial hemorrhage... Teacher, is Duan Hongwei a subarachnoid hemorrhage? Zhou Yuan asked one last question.

He Jian nodded

The two looked at each other and said at the same time, "Moyamoya disease." "

More than half of patients with moyamoya disease develop ventricular enlargement, with enlarged ventricles just on the same side as the lesion, and several right ventricles enlarged. Approximately 60 to 80 percent of patients with moyamoya disease will have intracranial hemorrhage, especially in the subarachnoid hemorrhage.

The enlargement of the ventricles and the subarachnoid hemorrhage in the skull, the combination of the two, can basically determine that Duan Hongwei has moyamoya disease.

Moyamoya disease is a disease of unknown cause, which is mainly characterized by chronic progressive stenosis or even occlusion of the end of the bilateral internal carotid artery and the anterior cerebral artery and the beginning of the middle cerebral artery.

The reason why it is called moyamoya disease is because this abnormal vascular network at the base of the skull looks like a cloud of smoke in the cerebral angiography image, and the small vascular network is narrowed and blocked, which makes the cerebral angiogram look very chaotic and difficult to distinguish.

There are four main types of the disease, i.e., the four main clinical manifestations.

Transient ischemic attacks are the most common, accounting for about 70% of patients with moyamoya disease, characterized by hemiplegia, that is, one limb is completely paralyzed, and some patients with moyamoya disease are more serious, which is alternating hemiplegia between left and right, and the left limb cannot move for a while, and the right limb cannot move for a while.

Moyamoya disease of transient cerebral ischemia is mostly benign, with a tendency to spontaneously relieve the fire and stop completely, and it will not cause any effect on the body after the attack.

There is also infarction, which can cause acute stroke, that is, stroke, accompanied by persistent paralysis, aphasia, visual impairment and even intellectual disability.

The epileptic type consists mainly of frequent seizures, and there is also a hemorrhagic type, which manifests as intracranial hemorrhage, mainly subarachnoid hemorrhage.

Duan Hongwei's moyamoya disease is likely to be between the first and fourth types - transient cerebral ischemia and intracranial hemorrhage.

"There is no warning before the onset of moyamoya disease, although there is stenosis, but soon there will be collateral circulation to compensate for the blood, occasionally dizziness, but... No one would go out of their way to have a cerebral angiography..."Zhou Yuan lowered his head, and basically concluded that Duan Hongwei was suffering from moyamoya disease.

This is a very rare cerebrovascular disease, and there are currently no effective drugs for moyamoya disease internationally, but for some patients with chronic stage moyamoya disease, some vasodilators to resist vascular stenosis, antiplatelet aggregation and anticoagulants may be beneficial.

In 2012, the medical community in China proposed oral antiplatelet coagulation drugs to treat ischemic moyamoya disease, but there was a lack of sufficient clinical evidence, and it was later discovered that long-term use of antiplatelet coagulation drugs, such as aspirin, not only will not make the condition better, but also transform ischemic moyamoya disease into hemorrhagic moyamoya disease...

Drugs don't work, and surgical treatment is helpless.

Although the medical community has proposed intracranial and extracranial revascularization surgery, it is theoretically true, since the vascular network is entangled and narrowed occurs, the blood vessels are dredged, reduced, and reconstructed.

However, theories are just theories, just like Zhou Yuan's reconstructed finger surgery, R, M countries, which country has not thought of using toes with similar shapes to transplant fingers? But in the end, only Zhou Yuan succeeded in practice.

And this practice also made Zhou Yuan the father of reinvention fingers.

The same is true for moyamoya disease. _

Feilu reminds you: there are three things to read - collection, recommendation, and points