It took some time to read the cases, but Dr. Pascal read them a lot faster than Sun expected. After about twenty minutes, Dr. Pascal, who was only half seen by the patient, put down what he was holding and asked with a frown, "This patient ...... It's kind of weird. ”

"Of course it's weird. Sun nodded, "The fact that the two biopsies didn't reveal anything of value is unusual in itself – the sampling was taken directly from the mass area shown on the image." ”

"These occupancy areas are not necessarily real occupancy. Dr. Pascal raised his case to Sun, "Inflammation may also appear as a hypointense area on MRI. ”

"Inflammation?" Sun Lien frowned, "You think...... This could be ...... Some kind of autoimmune disease?"

Dr. Pascal spread his hands, "This kind of question, if you ask the oncologist, he'll say it's multiple gliomas, and if you ask the genetic disease doctor, he'll tell you it's some kind of genetic disease that the ghost knows the name of." I have indeed seen patients with somewhat similar symptoms before. So if you ask me today, of course I'm going to think it's probably an autoimmune disease — it doesn't matter what we say, what matters is how you should verify what we say. He stared at Sun Lien and said seriously, "We can only provide ideas, and it is your job to identify and verify these ideas." ”

Sun Lien was still trying to absorb and digest Dr. Pascal's answer, while Lao Pa continued, "From the analysis of the lesion area, these masses are basically next to the lateral ventricles and around the major blood vessels. And the following cord stripes, I have some other opinions. ”

Multiple hypointensity opacities are indeed mentioned on the imaging report. This hypointensity is interpreted by imaging doctors as a "mass lesion". Dr. Pascal, however, had a different view.

"Hypointense opacities on MRI generally appear in places where the water level is significantly higher than that of other tissues. He explained to Sun, "The biopsy also said that the microscopic interstitial showed slight edema – which can also be used to explain the source of the low signal." ”

Sun Lien glanced at the case again, then shook his head, "If it is interstitial cerebral edema, then its imaging features should be as streaks with clear borders around the ventricles - this is inconsistent with the existing imaging evidence of multiple hypointensity." In addition, Yuanhai Hospital has already done lateral ventricular drainage for the child, and if it is a lesion caused by interstitial cerebral edema, her condition should at least be stabilized after lateral ventricular drainage, rather than further deterioration. ”

"I'm just saying that these areas may be edema, but not necessarily interstitial cerebral edema. Dr. Pascal shook his head, "I have a bold idea—but you wait. He lowered his head and began to flip through the previous case again, and began to sketch on it with the pen in his pocket. Soon, he finished his labeling work and said, "The child was treated with hormone pulses for six days after his first admission, but the treatment did not respond well. ”

Sun Lien knew this, and he nodded, "And then?"

The hospital then gave the child a first AQP4 antibody test, and the test result was negative. Dr. Pascal continued to keep his head down, "After a month, the child was discharged. After two weeks, they were transferred to another hospital for treatment – the new one adopted a similar strategy, hormonal shocks. ”

The logic of the doctors at these hospitals is similar to Dr. Pascal's hypothesis, and they all believe that these hypointense areas are not necessarily tumors, but more likely to be aseptic inflammation. Therefore, the first treatment to be taken is hormone pulse therapy. It's just that the two hospitals use different hormone drugs and dosages.

"The third, the fourth...... Even the capital's Tongxiep Hospital has adopted a hormone shock regimen. Dr. Pascal shook his head and said, "But it's all useless." ”

This sounds like a simple description of the previous treatment. Sun Lien frowned and thought about it, but he didn't find any problems in this.

"They all made the mistake of trying to control the condition first and then refining the tests. Dr. Pascal shook his head, "Under hormone pulse therapy, the first thing that affects is the APQ4 antibody. He looked at Sun Lien and said seriously, "I don't think that at least NMO can't be ruled out so easily." ”

Neuromyelitis optica (NMO) spectrum disease is a target of suspicion that has been ruled out at the outset of the entire treatment process. The reason is also very simple - many hospitals have conducted relevant tests for Tang Min, and the APQ4 antibody test has always been negative.

"Just because she has negative antibodies doesn't mean she doesn't have NMO. In response to Sun Lien's question, Dr. Pascal simply shook his head and said, "There are some NMO patients who will have false negative AQP4 antibodies after receiving hormone shocks. And these people......" he suddenly showed a somewhat mysterious smile, "they have one more thing in common. ”

"None of them are sensitive to hormone pulse therapy?" Sun guessed along Dr. Pascal's train of thought, and then got an affirmative answer.

"For patients like this, the effect of plasmapheresis is much better. Dr. Pascal nodded as he handed back the medical records, "I think that if you want to rule out NMO, you should do at least two plasmapheresis to see the effect." ”

Sun Lien hesitated for a moment, then put aside the case handed over by Dr. Pascal. "This thing...... I still think something is wrong. ”

Neuromyelitis optica spectrum disease gets its name because the diagnosis of this disease requires both an inflammatory response of the optic nerve and the spinal cord. Taking a step back, assuming that Tang Min is really an AQP4 antibody-negative NMO patient, then she should also show symptoms of myelitis. But she doesn't show any signs of myelitis — either imaging or actual symptoms. Under these conditions, it is necessary to identify Tang Min as an NMO patient...... It's completely impossible.

A recent MRI scan also confirmed that she showed no signs of spinal cord inflammation. Sun added, "NMO patients who are negative for AQP4 antibodies must first meet the conditions of NMO, right?"

"I don't know. Dr. Pascal said with a face, "Anyway, since you don't have any other ideas of particular value right now, why don't you consider it? He looked at the case on the table, looking a little helpless, "Even if plasmapheresis doesn't work, her condition won't be worse." That's at least a well-founded cure, isn't it?"