Chapter 612: The spinal cord is a neural forbidden zone, a female patient who sees things in pairs
It is definitely a blessing for patients to meet a doctor like Zhou Can.
He is responsible, compassionate, highly professional, and has a wide network of contacts. When encountering difficult cases, he is often able to consult with top experts in the corresponding departments at the first time.
Yin Hua picked up the information and looked through it carefully, but did not make any comments easily.
Almost all experts agree with this.
They will never make any comments on a condition they are not sure about, and they can control their mouths very well.
Unlike some young novice doctors, who are eager to take credit for their discoveries and are eager to show off their medical skills. This is exactly what people often say: a full bottle does not make a sound, but a half-full bottle of water will cause a stir.
The more powerful a person is, the more humble he is.
People who have no strength are particularly vain because of their inferiority complex.
Zhou Can picked up the cup and drank tea, waiting patiently for Director Yin Hua to finish reading the information.
"There are only two reasons why this child is paralyzed. Either there is trauma to the cervical spine or there is brain injury."
After careful study, Director Yin Hua gave a diagnosis.
"Do you think so too? At the beginning, I suspected that the patient's cervical spine injury caused high paraplegia. Because the patient's neck was red and swollen after the fall."
Before Zhou Can came, he naturally had a certain diagnostic conclusion.
Director Yin nodded.
"The cervical vertebrae contain the spinal cord, which is an important part of the human nerves. It is almost impossible to recover from spinal cord injuries. If the spinal cord is damaged, this child will probably have little chance of recovery."
Director Yin has extensive clinical experience and has seen a wide variety of cases.
Many half-baked doctors only know that the brain stem is a life-forbidden zone, but experienced surgeons or neurologists believe that the spinal cord is more fragile than the brain stem and more difficult to repair.
If the brain stem is called the forbidden zone of life, then the spinal cord is definitely qualified to be called the forbidden zone of nerves.
If ordinary nerves are cut or damaged, doctors can still perform nerve anastomosis with their superb medical skills. However, if the spinal cord is damaged, the best result is paralysis of the lower body, and it is likely to be lifelong paralysis.
It will be difficult for me to stand up from the wheelchair again in my life.
Speaking of this, we must talk about lumbar puncture and bone marrow puncture, two of the four major clinical punctures.
Many patients believe that lumbar puncture is very dangerous because the tissues it needs to pass through are the skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, and yellow ligament, which is the epidural space, where epidural anesthesia is generally given.
Then continue to insert the needle to pierce the dura mater and arachnoid membrane and enter the subarachnoid space. The lumbar puncture is considered a success only when cerebrospinal fluid flows out.
Patients believe that lumbar puncture is dangerous, mainly because of misunderstandings about spinal anesthesia.
After spinal anesthesia, the lower limbs completely lose sensation and the feeling is no different from lower limb paralysis.
Therefore, many patients believe that if the lumbar puncture is not performed properly, it will cause them to become paralyzed. This is possible, but it is very small.
There will be two missed beats during lumbar puncture. Doctors with good hands and a flexible mind can basically learn how to do it. In addition, the instructor and senior doctors will explain some of the key points in detail and provide strict guidance during the actual operation.
After all, everyone is afraid of something happening.
No one can afford to let interns or residents paralyze their patients.
So relatively speaking, lumbar puncture is a very safe puncture.
On the contrary, the bone marrow puncture, which is not paid much attention to, has a type of procedure called spinal process puncture. This puncture is actually more dangerous.
Especially when encountering a novice doctor who is ignorant of the depths of the situation and fearless, the patient can refuse the treatment out of consideration for his or her own safety. Let a senior doctor do the operation instead of being treated as a guinea pig.
If something goes wrong, your life will be ruined.
Of course, the chance of something going wrong is less than 99.9%. It is unlikely that something will go wrong even once in 10,000 times.
Even if the probability is one in ten thousand, it would be a disaster for any patient.
If it can be avoided, we must definitely try our best to avoid it.
For some dangerous operations, if the patient has strong doubts, senior doctors who are proficient in this technology are obliged to perform them personally, rather than leaving it to interns.
"The human body's nerves are divided into two parts, the central nervous system and the peripheral nervous system. In clinical practice, nerve anastomosis is generally performed on the peripheral nervous system. The central nervous system is generally difficult to repair surgically. At least with the current medical technology and level, the central nervous system is still an area that has not been conquered. The spinal cord is part of the central nervous system."
Director Yin Hua continued to explain his clinical diagnosis and treatment experience about nerves to Zhou Can.
"The length of an adult's spinal cord is generally around 42cm to 45cm. It is hidden deep inside the spine and is generally not easily damaged. This is also a form of self-protection that we humans, and even more so than most mammals, have developed over countless years of evolution."
In addition to supporting the body, bones also have another function, which is to protect important organs and nerves.
For example, our most important brain is wrapped by the entire skull and forms a spherical shape.
This is also the result of long-term natural evolution.
The round shape is the least vulnerable to damage. The hard skull grows into a spherical shape, which can protect the brain and important brain tissues to the greatest extent.
The evolution of the spine is even more interesting. The vertebral column is round, but the vertebrae are somewhat triangular.
The round shape is not easily damaged by external forces and can resist external attacks to the greatest extent. Even plants have learned this in the process of evolution. The trunks of trees are almost all cylindrical.
Because the cylindrical shape is more stable and not easy to break or be damaged by external forces.
The trunk must support the weight of the entire crown and branches and leaves, and not break in harsh environments such as strong winds and heavy snow, so it must be cylindrical.
Perhaps in the earliest times, some trees had non-round trunks, but they were eliminated in natural competition.
So now all you can see is the cylindrical trunk.
The evolution of the spine into a circle is definitely the most in line with nature and the most adaptable to the laws of nature.
The spine is a bit like a triangle, which is also the result of natural evolution.
The triangle is the most stable shape.
For the spine to support the entire upper body, it must be stable and strong.
"If the spinal cord is injured, my clinical experience is that the closer it is to the head, the lower the chance of recovery. In clinical practice, some patients with lower limb paralysis due to spinal cord injury were eventually able to stand up again and recover their original motor and neurological functions after tenacious rehabilitation training. In most cases, this is because the injured spinal cord is close to the coccyx."
There is actually no such thing as coccyx in medicine.
However, older doctors often refer to the part of the spine close to the buttocks as the coccyx.
Humans should have had tails in the beginning.
Because it turns out that the vast majority of animals have tails.
However, during the evolution of humans, the tail eventually disappeared and the body became smooth, leaving only the skin.
To be honest, this kind of evolution of human beings is not conducive to adapting to the harsh environment of nature, but human beings have evolved into advanced civilization. They have solved the problem of food and clothing, have houses to live in, and have cars, planes, ships and other means of transportation to travel. They no longer need to be exposed to wind and rain like wild animals, running around hunting in the primeval forest, and evolving towards a more beautiful direction. This is a natural miracle.
Looking at all animals, except humans, other animals are either protected by thick scales or shells, or have thick hair or even spikes.
No one knows whether there are gods in this world.
But human beings are the most superior species on earth, there is absolutely no doubt about that.
Imagine if our girlfriend was a person with black hair all over her body, how would it feel? Some men have excessive body hair because of excessive male hormones.
The arms, chest, abdomen, legs and other parts are covered with long hair.
Does this mean that evolution is slow?
No one can tell.
Studies have shown that men with more hair on their bodies are stronger, have stronger immune systems, and are better at having sex.
The immune system of wild animals is definitely stronger than that of humans. From another perspective, it can also be understood that male compatriots with thick hair are not as evolved as male compatriots with delicate skin and smooth body.
In the Bible and many Western mythology books, angels are described as having fair skin and beautiful looks, rather than having black hair all over their bodies like apes.
When Director Yin Hua shared his clinical experience, Zhou Can just listened quietly.
He learned another thing today: the closer the spinal cord is to the head, the harder it is to recover.
"Director Yin, I did a test on this child, which is the knee jerk reaction. After the test, I found that his knee jerk reflex exists in both legs, which shows that the lower nerve center should be unobstructed. However, his left leg knee jerk reflex is normal, while the right leg is obviously much weaker. At the same time, I also found that his right neck is stiff..."
Zhou Can also repeated his analysis and findings.
"you mean?"
After listening to this, Director Yin's eyes lit up slightly and a smile of appreciation appeared on his face.
Zhou Can often uses some unexpected methods in diagnosis.
Many seemingly ordinary methods can be transformed into magical ones in his hands and become the key ideas for solving difficult cases.
"I suspect that the high-level paraplegia is not caused by cervical spine injury. But as you said, there are only two parts that can cause high-level paraplegia, either the cervical spine or the head. You have also seen the patient's head CT and color Doppler ultrasound, and there is almost no abnormality. I seem to have entered a dead end in diagnosis, so I came to ask you for advice."
What Zhou Can fears most in clinical diagnosis is encountering this kind of vicious circle.
I finally found a diagnostic clue, but after much effort, I discovered that the clue was wrong.
As you can imagine, the doctor must be very desperate in this situation.
From finding a clue, determining the direction of diagnosis, and then doing a series of examinations on the patient, even in this process, it is necessary to consult with other doctors. In the end, it is found that this diagnostic idea does not work.
At this time, either give up.
Or find other diagnostic ideas.
"Okay, I'll go to the ward to check on the child's actual condition. Neck stiffness usually doesn't occur on one side, but on both sides at the same time. This should be one of the clues to a breakthrough in diagnosis."
Director Yin thought about it and then said this.
"Okay, I'll go with you to the ward. The child is in the emergency surgery ward."
Zhou Can stood up and said to him.
Director Yin quickly raised his hand and pressed down, motioning Zhou Can to sit down.
"No, no, no, just sit in my office. I also have a difficult case here, and I don't have any idea about it either. Please help me study it." After he said that, he handed the patient's information directly to Zhou Can.
The two of them exchanged with each other.
This kind of thing has happened more than once or twice.
Zhou Can asked another chief physician for help. Why respond to his request?
Because after they helped Zhou Can, whenever they encountered problems, they would ask Zhou Can for help, and he would always respond to their requests.
Sitting in Director Yin's spacious office, Zhou Can drank tea while studying the patient's information.
This is a female patient, only 32 years old, quite young.
The main symptoms of the patient's admission to the hospital were headache, blurred vision, frequent double vision, and occasional twitching of the limbs.
After reading the main symptoms, the first thing Zhou Can thought of was epilepsy, which is commonly known as epilepsy in medicine.
This disease can be both inherited and acquired.
Although this disease is easily inherited, it is not contagious to others. So if you find out that your partner has epilepsy, don't be afraid. Just take good care of him/her when he/she is ill, and this will actually increase the affection between you.
Danger is most likely to occur during an epileptic seizure.
For example, when riding a bicycle, if you suddenly have an epileptic seizure and lose consciousness, it is easy for you to hit an obstacle on the roadside and fall.
If you fall into the water near a river or pond, you may drown.
If you are doing some dangerous work, such as working next to a machine, and lose consciousness and are sucked into the machine, you will be beaten into a pulp.
In general, epilepsy can be controlled with medication to reduce the number of seizures.
Even prevent it from happening.
This cost is high and lasts a lifetime, so many families cannot or are unwilling to afford it.
Zhou Can first checked the medical records to see if the patient had a family history of the disease.
The female patient's parents and grandparents are all healthy, with no diseases such as epilepsy and no history of mental illness.
Only her grandmother developed senile dementia, commonly known as Alzheimer's disease in medicine, when she was old.
This disease is completely unrelated to the woman's illness and can be ignored.
After ruling out a genetic history, Zhou Can began to carefully study the female patient's examination results and disease course.
This is the first time this disease has occurred in this female patient.
About two months ago, she started to have headaches, but because she was busy with work and had a lot of housework to do, she didn't go to the hospital for a checkup.
At first I thought I didn’t get enough rest, and thought it would heal on its own after a while, so I didn’t take any medicine or go to the doctor.
The headache lasted for about a month, and her condition did not improve but worsened. She also had double vision.
At first, it was just occasional double vision, especially in the morning when I first woke up.
Later, the condition worsened again. Not only did the headache become more severe, but double vision became the norm. He also developed limb convulsions.
However, there was no foaming at the mouth.
If it is the legendary pig-woman madness, foaming at the mouth will usually occur when the disease occurs.
When Zhou Can saw this, he felt that the female patient's illness was not simple. No wonder even Director Yin Hua and the doctors in the Department of Neurology could not find out the cause.
