Returning to the interventional department, Lin Yuan reported everything he knew to Boss Zheng. She had had an attack once before, and she was cured after taking medicine to treat facial paralysis without any sequelae. She even reported the migraine that she thought was unimportant to Boss Zheng.
If you talk longer and have more symptoms, you will appear to be more serious.
And she did not emphasize that the patient should undergo surgery, and she did not get first-hand information. For a person like Boss Zheng, no matter how much he emphasizes, it is useless, and Lin Yuan knows it well.
"Su Yun, what do you think?" Zheng Ren asked.
"Don't smoke, don't drink, what's so easy about life at a young age? Life is fun, do you want to go to nightclubs when you get older?" Su Yun nagged.
For him, who smokes and drinks, Yang Lixin is a typical example of his opposite, "evil".
"I didn't do a good job asking about the medical history. If Sister Yue goes there, I will definitely know more details." Before Boss Zheng got angry, Lin Yuan examined himself and admitted his mistake.
This method is very useful at home. Every time the meow meows, no matter what happens, everything is over. Although Boss Zheng didn't like this, Lin Yuan still habitually called out first.
Maybe if this is the case, Boss Zheng can be more gentle.
"You asked very well. The condition is basically clear." Zheng Ren smiled lightly.
"Well… "
This sentence was more unacceptable to Lin Yuan than being scolded.
Is the condition clear? Make it clear! Where is it clear that I don’t smoke, don’t drink, and often stay up late? Or something else.
"Oh? Do you suspect a patent foramen ovale?" Su Yun asked, "Is it because of migraine, plus a suspected cerebral infarction, and a cerebral infarction?"
"If there is only one point, there is no way to diagnose it. If two points are combined, the possibility of a patent foramen ovale is very high." Zheng Rendao.
The diagnostic criteria and clinical symptoms of patent foramen ovale flashed in Lin Yuan's mind.
The book clearly states that patients with patent foramen ovale are often asymptomatic, making it difficult to hear murmurs, and electrocardiograms and chest X-rays are normal. Therefore, it is not easy to find and is not taken seriously by people.
Lin Yuan even thought of the information written many years ago that on average, one out of 4-5 people has a patent foramen ovale.
Because most patients have no symptoms, there is a high chance that the disease will go undetected throughout their lives.
It has long been believed that patent foramen ovale generally does not cause shunting between the two rooms and has no impact on the hemodynamics of the heart, so it is considered "irrelevant".
Is this how Boss Zheng diagnosed it
Su Yun glanced at Zheng Ren, frowned and said, "Boss, did you start to suspect this young man's cerebral infarction?"
"Absolutely. There has to be a reason not to." Zheng Ren said, "The probability of migraine caused by patent foramen ovale is very high. A considerable number of patients have migraine, but it is difficult to diagnose, all because of patent foramen ovale. Caused.”
"Contradictory cerebral infarction, it turns out that this is what you have always suspected." Su Yun smiled, "So you asked Xiao Linzi to ask about the medical history?"
"Well, as long as there is a migraine, there is a high probability that it can be diagnosed as paradoxical cerebral infarction. A transesophageal ultrasound... is still relatively difficult, and a foaming test may be required."
"Boss Zheng, please wait a moment." Lin Yuan immediately stopped what Boss Zheng was saying. If he continued talking, he would even know how to treat it, and the study of a case had come to an end.
But he had no clue at all.
Lin Yuan knew about paradoxical cerebral infarction. Generally speaking, cerebral infarction is caused by arterial thrombosis. However, some people do not have emboli in their arterial system, but emboli in their venous system can embolize to the blood vessels in the brain through the patent foramen ovale.
This is also a theoretical basis for the current medical community's tendency to treat patent foramen ovale once paradoxical cerebral infarction is discovered.
"You want to ask what is the relationship between migraine and patent foramen ovale?" Zheng Ren asked.
"yes."
"There is currently no clinical explanation with theoretical basis." Zheng Ren smiled and said: "But there are several guesses. First, the unexplainable migraine may be due to some neurotransmitters in the venous system passing through the patent egg. The round hole bypasses the inactivation and filtering functions of the pulmonary blood vessels and directly reaches the cerebral circulatory system, where it combines with some receptors on certain nerves to produce migraine symptoms."
“Second, when the foramen ovale that is not completely closed opens during deep breathing, coughing, exercise, etc., tiny thrombus in the venous system enters the cerebral circulation through the foramen ovale, aggravating the spread of cortical spreading depression, which is also the beginning of migraine. Discover the phenomenon.”
Lin Yuan sighed inwardly. It seemed that his diagnostic skills were not good enough.
"When encountering an unexplained cerebral infarction, the recent theory is more inclined to check the heart." Zheng Ren continued, "A patent foramen ovale is also a predisposing factor."
Cerebral infarction requires a cardiac color Doppler ultrasound, and it is also related to migraine... Lin Yuan sighed deeply again.
They all say that you should not treat a headache or a pain in the head or feet, but I didn't expect that I would be taught another lesson today.
Su Yundao: "Do you want to have a B-ultrasound yourself?"
"No need." Zheng Ren said, "Do you have anyone familiar with you in the Department of Neurology?"
"I have dealt with the hospital manager before, but do you know people in the internal medicine department? I don't have deep contact with them." Su Yundao said, "Do you want me to remind you?"
"Well, do a transesophageal echocardiogram, or do a foaming test, whatever is convenient, to check for a patent foramen ovale. If there is, there is a high probability of recurrence in the future. See the circulatory department. The interventional doctor just blocked it."
"Look how much intervention will delay things. This used to be a job of the heart." Su Yun glanced at his boss, and all his resentment was piled on him.
"The Circulation Department now mainly performs cardiac interventional surgeries. Who do you blame for this?" Zheng Ren said.
"Let me first ask if they have checked. Don't let us get too excited here. The neurology department has already finished the operation and examination. It would be so embarrassing." Su Yun changed the topic and changed the direction.
"That's fine, as long as you don't miss this point. If the attacks occur one after another and one of them is not opened, the patient will be miserable in the future." Zheng Ren said casually, not caring.
It's not a bad thing to just let this matter go. Su Yun reminded the patient that the diagnosis might have been ignored, without arousing any suspicion. Lin Yuan did a good job in this matter.
Well, Fu Gui'er will be gone in a few days. I have to teach her how to perform surgery. If there is any mistake, I will use a hemostatic forceps to tap it.
Lin Yuan didn't know that because of a migraine, he had gained Boss Zheng's "attention".