"You can't say that. We have at least ruled out several possibilities." Zheng Ren's expression was as serious as when Su Yun and Zhou Litao were teaching and solving doubts.
"What are you thinking about now?"
"The most common one that can be affixed is formaldehyde poisoning." Zheng Rendao: "Mild poisoning has systemic symptoms such as blurred vision, dizziness, headache, and fatigue. Severe poisoning can cause pulmonary edema and hypoxia. Symptoms such as cramping can occur.”
"It's not like that." Su Yun shook his finger, "First of all, it is difficult for the condition of formaldehyde poisoning to continue to progress after being separated from the toxic environment. We don't say that it will be directly relieved and become like a normal person, but it will evolve from loss of smell to convulsions. , it’s unlikely.”
Zheng Ren also felt that this diagnosis was a bit forced, and Su Yun's judgment was correct.
He continued to ponder, tapping his fingers lightly on the table. Su Yun felt that if this guy got old, he would be like old Director Pan.
Or maybe he imitated old Director Pan intentionally or unintentionally.
"It's not formaldehyde poisoning, it's not sulfur dioxide poisoning, it's intracranial tumors? This possibility..." Zheng Ren said softly while thinking.
"You also recite it during the exam? Isn't it annoying?" Su Yun said disdainfully, "Do you want to take your fifth edition of Surgery to the hospital-wide consultation in the future and recite it section by section?"
"Hmm..." Zheng Ren continued to mutter as if he didn't hear Su Yun's sarcasm, "Moreover, it's just an illusion. I felt like I couldn't smell anything, and then I had a seizure."
"You can write fantasy novels. If there is such a situation, it will appear sooner or later, but it will appear in the CT room. Isn't this nonsense?" Su Yundao said.
"If we have seizures, would it be better if we think of the word as epilepsy? For example, reflex epilepsy syndrome.
Almost all seizures are epilepsy induced by specific sensory or complex cognitive activities, such as reading epilepsy, startle epilepsy, visual reflex epilepsy, heat bath epilepsy, card epilepsy, etc. Remove the triggering factor and the attack disappears. "
"You mean..." Su Yun was also confused.
"Claustrophobia is usually more obvious during MRI. But there are also patients who develop the disease during CT. During SCI... "
"Stop showing off your data. Epilepsy is possible, but can it explain the loss of smell?" Su Yun continued to find fault.
Indeed, Su Yun was right.
This is like pressing the gourd and letting the gourd float. Loss of sense of smell and epilepsy cannot come together.
Besides, claustrophobia is a rare thing.
Zheng Ren let out a sigh of relief and continued to think.
"Hey, do you want me to ask about other medical history?" Su Yun said with a smile.
"Are you looking for Zhou Litao?"
"Who knows, let's ask the nurses first, in case they can provide useful information."
"If you want to have some fun, go and don't ask for medical history." Zheng Ren said, "In fact, epilepsy and loss of smell can go together."
"For example?"
"Antihypertensive drugs can improve heart function, but occasionally can damage the olfactory nerve."
"It's too far-fetched."
"Abnormal discharge of brain cells and neurons... Nerve damage..." Zheng Ren started talking again.
"Don't think that just because you talk about epilepsy and the abnormal discharge of brain cells and neurons will make you look more professional," Su Yundao said.
"That's not the case..." Zheng Ren raised his hand and said, "Nerve damage does not necessarily have to be trauma. Other factors may also cause nerve damage."
"Tumor invasion, chemical elements dispersed in the air, what else do you want to say? These have just been diagnosed."
“Parasites, such as amoeba, first enter the human nasal cavity, are ingested through the supporting cells of the olfactory neuroepithelium through phagocytosis, and then pass through the cribriform plate along the mesangium space of the unmyelinated olfactory nerve terminal filament. Afterwards, arriving…”
Zheng Ren said and was stunned.
Su Yun's eyes were also a little confused, and he looked at Zheng Ren in surprise.
Originally he wanted to refute, but primary amoebic meningoencephalitis does have loss of smell and symptoms of epilepsy. When the words came to his lips, Su Yun swallowed them back.
Well…
"It's primary amoebic meningoencephalitis!" Zheng Rendao, then added: "This diagnosis is relatively reliable, the probability is 80%!"
"Is it primary amoebic meningoencephalitis? How did you get in?"
"Ask Mr. Zhou if there are any wounds near the patient's nose. By the way, how old is the patient? It may be that the acne has been squeezed and infected with amoeba."
The more Zheng Ren said, the more confident he became.
Because the previous diagnostic flaws were too obvious, they could be eliminated with basic logic. They are a type of differential diagnosis, a sacrificial diagnosis that finds reasons to be denied.
"At first, there was an abnormal sense of smell, but then there was dizziness, headache, nausea, projectile vomiting, and then epilepsy." Su Yun frowned and gave a reason that he was not sure about.
"Different locations of infection may lead to intermittent progression of the disease." Zheng Rendao said: "The disease is very complex, and the steps in the textbook are just the ones that will happen with a high probability."
Sure enough, Su Yun's words were immediately refuted by Zheng Ren.
Zheng Ren then picked up his cell phone and called.
But the phone ringing came from the door, and Zhou Litao then pushed the door open and came in with his mobile phone.
"Boss Zheng, Brother Yun, I'm sorry, the patient had an emergency and came back late." Zhou Litao said apologetically.
"Is there any trauma to the patient's mouth and nose triangle?" Zheng Ren asked directly.
"Uh... no." Zhou Litao said, "No external injuries."
Zheng Ren was a little disappointed, but immediately asked: "How old is the patient?"
"An old man in his sixties." Zhou Litao replied subconsciously.
Could it be that I thought wrong
"Boss Zheng, what disease are you considering?" Zhou Litao asked cautiously when he saw Zheng Ren's unkind expression.
"No trauma? Where's the rosacea?"
"Uh..." Zhou Litao was stunned for a moment, thinking what happened to Boss Zheng
"I have rosacea, and the patient drinks a lot of alcohol all year round. For the time being, I think the convulsions are caused by alcohol." Zhou Litao immediately said more to save Boss Zheng from chasing him with questions.
"No! It's primary amoebic meningoencephalitis." Zheng Ren said: "Sedate the patient and seize the time to do a CT scan. By the way, we also need to do a cerebrospinal fluid examination."
“…”
Zhou Litao had just been busy and sweating, and when he came back, he was told that he was confused by Zheng Ren. He was even more confused than when Su Yun was teaching him.
"Rosacea has a very small chance of developing amoeba infection when it comes into contact with raw water. The incubation period is short and the onset is sudden." Zheng Ren said with certainty: "Let the doctor in the inpatient department check the cerebrospinal fluid immediately and do a CT scan. .”