The patient complained of unsteady walking, no vertigo, and no signs and symptoms of cerebellar ataxia. At present, all blood tests and imaging tests of the patient have found no abnormalities. ”

"Combined with these conditions, I believe that the patient's diagnosis is 'neurosis', and the use of gamma oryzanol and bus mixture can be considered for treatment, and I am done."

The meaning expressed by Tan Xiaomin has been fully demonstrated when he reported his medical history. Ling Xiaoyun asked him to say it again, and he wouldn't say anything new.

After Tan Xiaomin finished speaking, none of the other doctors took over his topic. There was silence in the office.

"Let me say a few words." Seeing that everyone was silent, Ding Feng spoke.

"I basically agree with Dr. Tan's analysis just now. I have a question, generally speaking, most patients with neurosis are women, and this kind of patient is more sensitive in personality and is very concerned about various discomforts in their body. ”

However, this patient does not seem to have such characteristics. So, I have reservations about this diagnosis, but I can't give a definitive diagnosis either. Ding Feng, who was upright, expressed his suspicions.

"I also agree with Dr. Ding's suspicions. The patient is male, with a subacute onset and a complaint of unsteady walking, which is not characteristic of general neurosis. ”

"Although the current head CT has not found evidence of cerebellar atrophy, I am more inclined to believe that the patient may be in the early stage of primary cerebellar atrophy, which is worth continuing to follow." Zhuo Guangming's speech is more reasonable. Everyone, including Ling Xiaoyun, nodded frequently.

"I'll tell you about it." Lin Lin immediately spoke.

"Wait, Dr. Lin, you'll talk about it later." Ling Xiaoyun immediately stopped Lin Lin's speech. Ling Xiaoyun was not stupid, she knew that Lin Lin's speech mostly meant the end of the discussion. Because, most people, take Lin Lin's speech as their own opinion.

"I agree with Dr. Toh that this patient should continue to follow up in the outpatient clinic and have regular head CT check-ups. As long as more than 5 sulci of the cerebellum are seen on the CT scan of the head, the diagnosis of primary cerebellar atrophy can be established. "This is Li Yun'e, another attending doctor in the Department of Neurology. She gave a quantitative indicator for diagnosing cerebellar atrophy, indicating that she has also put a lot of effort into it.

"I also agree with Mr. Zhuo and Mr. Li, this patient really can't be easily diagnosed with neurosis." Liu Yulan knew that she couldn't hide.

As the director, she can see how much effort they have put into this patient. Ling Xiaoyun still has this skill.

"Doctor Lin, tell me about it, looking at the way you are about to move, you must have your own opinions." Ling Xiaoyun always likes to "stab" Lin Lin in public.

Lin Lin smiled slightly, ignoring Ling Xiaoyun's words.

"I have a few different views on this patient, and if I say it, please correct the teachers."

"First, the patient is a 56-year-old man who developed the disease a month ago and has a tendency to progress slowly. Second, the patient's complaint is unsteadiness in walking. Men of this age, although their physical strength is not in the best state, but they are also strong and powerful, but they complain of unsteady walking, which deserves our attention. ”

"Thirdly, I did a detailed neurological examination of the patient last night, and found that the patient had the following clear signs."

"It is true that the patient has unsteady walking, but his unsteady walking is very characteristic, that is, when the light is not good, or when he walks with his head up, the shaking is very noticeable. Conversely, it is difficult to detect unsteady walking when the patient walks with his head down or in a well-lit environment. ”

"In addition to walking unsteadily, the patient actually had other positive neurological signs. For example, patients have deep sensory disorders, including tuning fork vibration sensation and joint position sensation. In addition, the patient's closed eyes are also positive. ”

"In addition, the tendon reflexes of the patient's limbs are active, and although no clear pathological signs have been eliminated, these pathological signs, at least not negative, are neutral or suspiciously positive."

"If you look closely at the skin of the patient's lower limbs, it looks dry and scaly, which is not the behavior of a person with normal neuronutrition."

Lin Lin's analysis was very clear, and everyone's attention was immediately attracted by Lin Lin's analysis, and they all listened attentively.

"I'll say a few more about the patient's laboratory tests. This patient's laboratory tests are actually problematic, and this question is consistent with my thinking about this patient's diagnosis. ”

"Oh, you found something wrong with the lab tests?" Ling Xiaoyun was surprised and interjected.

"Yes, the patient has mild anemia and a decrease in the number of reticulocytes in the blood. These two indicators are not very serious, and if you don't pay attention, it is easy to miss them. ”

"Combined with what I said earlier, the lesions of this patient, the site of damage, are mainly the posterior cords of the spinal cord, and the lateral cords and peripheral nerves are also affected, but they are not very serious, and this is my positioning diagnosis of this patient."

"As for the qualitative diagnosis, in my mind, it is also very clear, that is, subacute combined degeneration of the spinal cord."

"For the next treatment, I recommend the patient to be treated with vitamin B12. Well, I believe that the patient's condition will slowly get better as the treatment progresses. That concludes my statement. ”

Lin Lin's speech completely overturned the views of everyone in front of her, and it was reasonable.

"Dr. Lin, I also agree with your analysis. However, have you considered that the patient does not have an underlying disease that causes vitamin B12 deficiency, such as gastric resection, such as long-term alcoholism, such as long-term malnutrition, etc., this patient does not have any. Ling Xiaoyun asked her question.

Lin Lin believes that every doctor here will have such questions. Their knowledge was only limited to the point of the question raised by Ling Xiaoyun, without considering the deeper reasons. In the final analysis, they do not have the profound physiological and pathological skills like Lin Lin, let alone Lin Lin's meticulous observation and analysis skills.

"The director is right, the patient has no disease basis that causes vitamin B12 deficiency. However, we must be aware that these factors only hinder or reduce the absorption of vitamin B12 from food. ”

"We know that the body's use of vitamin B12 is dominated by active B12. In other words, all the vitamin B12 we absorb into the body must be converted into active B12 in the body to make sense. ”