In order to consult a patient who has been sedative and has fallen asleep, it is theoretically better to choose a psychiatric department with prescribing authority rather than a psychological counseling department. After all, most of the clinical psychologists in the psychological counseling department do not have the right to prescribe, and their main tools and means are interviews and various evaluation forms. For a patient who is in a coma, clinical psychologists can play very little role.

But Sun Lien's main purpose in asking for a consultation is to solve his doubts. Whether it is in Ningyuan Medical College, or in the emergency department of the Fourth Hospital, or in the training of Dean Wu Youqian and the old things, the content of the clinical psychiatry department is pitiful.

There is only one key question that Sun Lien wants to solve - when Cao Zhiquan was diagnosed with somatization disorder, what symptoms did the doctors who made the diagnosis see. With just one "somatization disorder", Sun Lien could not reverse deduce all the considerations of the attending doctor at that time. The prompt in the status bar allowed Sun Lien to directly lock the type of disease to a specific organ lesion, and what Sun Lien is racking his brains to figure out now is what difference he saw between himself and the doctor who diagnosed it at the beginning.

"If it's an SSRI (pentahydroxysex reuptake inhibitor)...... There should be no problem with re-administering sedatives after a few months. Dr. Lai Qianhong was silent for a while and then said, "But this diagnosis ...... I'm not sure. What symptoms the doctor saw at the time could only be determined after the detailed diagnosis records were delivered. ”

Sun Lien was silent for a while and then asked, "What if only based on his current symptoms? What is certain is that he has paroxysmal muscle spasms all over his body, and he has ...... Cognitive decline. Based on Cao Zhiquan's self-report and the medical history obtained from previous interviews with family members, Sun Lien was able to raise only these two symptoms. The head scan of the night emergency MRI has not yet been done, so these are the only two questions that can be asked.

"Somatization disorder will certainly be considered, but ...... Other problems have to be ruled out as well. Lai Qianhong shook his head after thinking for a while, "I will consider doing a head MRI for the patient first, and then see if there are any organic lesions." If the organic lesion is not severe or not at all, then I would consider MCI first. Somatization disorder is considered only after the MCI option has been ruled out. ”

MCI (mild cognitive impairment), translated in Chinese as "mild cognitive impairment". It's a state somewhere between normal and dementia. Patients may suffer from mild memory impairment, but it will not affect their daily lives too much. About 15 to 20 percent of people with MCI eventually develop Alzheimer's disease.

"Mild cognitive impairment, right? I know that. Sun Lien finally found a trace of what he had heard in the vast blind spot of knowledge, and after a few seconds of joy, he was troubled by a new question, "You mean, you suspect that this patient may have early-onset Alzheimer's disease?"

Lai Qianhong was stopped by Sun Lien's question, but the point he was asked was not "early-onset Alzheimer's disease", but "mild cognitive dysfunction". “MCI...... It seems to be called this, right? It's Mild cognitive impairment......" He raised his head and apologized to Sun Lien with some embarrassment, "I'm not very used to the mainland names for these diseases. ”

"That's exactly the name. Sun Lien was a little curious, "You're from Hong Kong? ”

Dr. Lai smiled, "Of course it's not like Hong Kong, I'm Taiwanese - I graduated from high school." ”

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When Dr. Lai left the office, Sun Lien reopened the computer in front of him and began to give medical orders.

Taiwanese doctor Sun Lien has never seen one before, but even if he did, he felt no different. Everyone is a colleague working in the four hospitals, and at most they are doctors from other places, who have never seen them before! What difference can there be? Anyway, everyone is Chinese.

However, I am not familiar with the translation of professional terms in the mainland, so this is a bit troublesome. It's no wonder that Dr. Lai used SSRI to refer to pentahydroxyselian reuptake inhibitor - it is estimated that the translation of this thing in Taiwan is still a little different from that in the mainland.

According to Dr. Lai, it still takes the results of a brain MRI to make a judgment. As long as the doctors in Jingwei Center are genuine doctors and not fake laymen, then they must have done the corresponding tests and ruled out the possibility of MCI before making a judgment on somatic disorders.

In other words, Sun Lien can now be sure that Cao Zhiquan's previous MRI results should be normal or only mildly affected, and there is absolutely no white matter hyperintensity, which is a hallmark lesion of MCI.

In this case, the diffusion-weighted imaging hyperintensity of the whole cerebral cortex suggested by the status bar is worth studying. In general, patients with cerebral ischemia, intracranial tumors, demyelinating lesions, and infectious brain abscesses often have hyperintensity on diffusion-weighted imaging of the brain.

But the whole cerebral cortex ...... I've never seen this before. Sun Lien gave the order for emergency MRI testing, and at the same time called up Cao Zhiquan's emergency blood test results. Sure enough, the indicators related to the infection were normal.

Other words...... Not an infectious brain abscess. Sun Lien rubbed his chin, which was a little prickly, and cerebral ischemia would cause abnormal brain function in patients, resulting in mental symptoms and cognitive limitations. But this ...... The doctors at the Jingwei Center shouldn't have gone unnoticed. After all, the symptoms of cerebral ischemia are too obvious, and as long as the brain is still functioning normally, doctors should basically not misdiagnose it.

So...... Could it be an intracranial tumor or a demyelinating lesion? Sun Lien first ruled out the possibility of demyelinating lesions. There are very noticeable and hallmark changes in this lesion, and patients will have a loss of sensation in the limbs in the shape of gloves and socks. With Cao Zhiquan's appearance of shouting and shouting everything, it is unlikely that he missed this point and did not mention it.

"So yes...... Tumor?" Sun Lien knocked on the table with a frown, the field of tumors was still unfamiliar to him. The reason is also simple, tumors are only likely to develop acutely in rare cases. Receiving cancer patients in the emergency department may only occur when the oncology beds in the hospital are full, and the patients from other hospitals are transferred to the hospital and there is nowhere to place them.

In other words, Sun Lien's understanding of cancer is basically similar to that of psychiatric diseases. Aside from the more general things he had taught in school, his knowledge of oncology came largely from occasional consultations and news.

If it is a brain tumor, does the diffusion-weighted imaging hyperintensity of the whole cerebral cortex mean that the cancer cells have spread to the whole cerebral cortex? Shouldn......'t this be? Cancer cells do not have normal cell function, and if cancer cells have appeared in the whole cerebral cortex, then the patient's consciousness and almost all the functions controlled by the brain should be greatly impaired. In this state, let alone manic yelling. He shouldn't be able to say a word, and he can't do anything except the occasional muscle spasm all over his body.

All possibilities are ruled out, but the evidence itself is here. This huge contrast in diagnosis made Sun Lien really have a headache.