"After your first treatment, are you completely well?"

"Let's just say that at least the urine and urine can be controlled, and the numbness has disappeared, but the strength of the hands and feet is still not as good as before. Also, after the last time I was hospitalized in Nanjiang Hospital, I have been feeling tired and palpitating. ”

"Is this still the case?"

"Yes."

"Did you feel any discomfort before you first became ill?"

"Hmm...... I remember, before the onset of the disease, sore throat, fever. ”

"Oh, got a fever? Remember how many degrees were the highest? ”

"I remember that the highest fever was 39.1 degrees Celsius, and the doctor quickly gave me medicine, and my body temperature quickly returned to normal."

"Okay, you lie flat, I'll check it out for you."

Lin Lin said that he would do the inspection.

This is the first time Huang Rui has seen Lin Lin do a physical examination, and his skillful techniques make Huang Rui very comfortable and deeply admired.

After the physical examination, Lin Lin told the patient that the doctor would try his best to find out the cause of the disease and carry out targeted follow-up treatment.

Lin Lin washed her hands and returned to the doctor's office to sit down.

"Let's discuss it." Lin Lin wanted to see what the situation of the department was like after Dong Huayu took over.

"I'm the doctor in charge, so I'll start with my opinion." Zhang Cuicui spoke first.

"The patient is a woman with recurrent incontinence and numbness and exertion in her limbs."

"Today, I saw Dean Lin's physical examination and found that the patient had obvious 'saddle-shaped' pain and tactile impairment, and the anal reflex disappeared."

At the same time, the patient also had numbness and weakness in the limbs, mainly in the lower limbs, but also in the upper limbs. The patient's pathological signs were contradictory, with decreased tendon reflexes in both lower extremities, but a positive Pap sign. ”

"After the patient was admitted to the hospital, he was very sensitive to hormone therapy, and his symptoms quickly improved dramatically, similar to the patient's first episode."

"For the localization diagnosis of this patient, I consider spinal cord damage as the mainstay, and the distribution of this damage is relatively scattered, with high spinal cord damage and low spinal cord injury."

"Among them, according to the medical history and physical examination results asked by Dean Lin today, I believe that the main lesion is between the 2-4 segments of the sacral medulla."

"As for the qualitative diagnosis, I still think that it is neuromyelitis optica that is mainly spinal cord damage."

"For the next step in diagnosis, I recommend doing an MRI centered on the sacral medulla 2-4."

"In terms of treatment, the original plan will continue to remain unchanged. I have finished my speech, and I would like to ask you to correct me. ”

"I agree with Dr. Zhang. I had to do self-reflection that the patient's 'saddle' sensory impairment was so obvious that we didn't check it out. ”

"It's not that we won't check, it's that we don't think about this aspect of the problem. I always have a question in my mind, isn't sacral cord damage, isn't constipation and urinary retention? Why does this patient have fecal incontinence? After acknowledging her shortcomings, Liu Yulan raised her confusion.

"This is the first time I have done a ward round with Dean Lin, and I have learned a lot from it. For example, how to take a medical history, how to pay attention to details, how to do a physical examination of the nervous system. ”

"I used to think that anyone could do the nervous system physical examination, and it was not a difficult task. Today, when I saw Dean Lin examining patients, I realized how superficial I was. ”

"Only a standard and comprehensive approach can find out the hidden signs of the patient."

"I also agree with what Dr. Zhang and Mr. Liu said just now. Professionally, there is still a lot to learn. Huang Rui's words came from the heart.

"From the time when Director Ding was there, I found that some problems that we thought were very simple, after Dean Lin's rounds, Dean Lin was always able to dig out a lot of details that we didn't notice."

"This patient, as Dr Huang said, did overlook important details, which made us feel lost and afraid to discharge the patient easily."

"Actually, I have the same problem as Mr. Liu." Dong Huayu did not analyze it again, but followed Liu Yulan to figure out this problem.

"I also agree with Director Dong's words. In Dean Lin's body, we have witnessed many miracles. Including what others can't diagnose, he diagnoses. What others didn't dare to treat, he did it, and he was cured. ”

"A patient like today, it seems simple, but it's actually very complicated. I have been practicing medicine for more than 30 years, and I dare not say for sure, because it is difficult to understand the neuroanatomy and function of the various parts involved in the middle. Ling Xiaoyun didn't dare to analyze this patient.

"There are so many interns and doctors here today, so I will take this opportunity to discuss and learn with you."

"This case is actually a good teaching material for learning spinal cord anatomy and urine and urine control pathways."

"I very much agree with what Director Ling said just now. I can feel Director Ling's caution, and this kind of caution is a quality that we doctors must have. ”

"There are no shortcuts to becoming a good neurologist. Everyone, must be familiar with and understand the clinical aspects of neuroanatomy, neurophysiology, neuropathology, and neurological disorders. Whether this knowledge is learned solidly or not will be reflected in the clinic. ”

"All the basics, you can find an outlet in the clinic. All the basic knowledge can provide strong support for clinical practice, and similarly, all clinical problems can provide a very ideal entrance for basic research. ”

"Specific to this patient, I recognize everyone's positioning diagnosis. Dr. Zhang's speech showed her solid basic skills and good logical thinking ability, and I hope that Dr. Zhang can maintain this style, and I am very optimistic about Dr. Zhang's future. ”

"Okay, back to this patient. Since the lesions are mainly located in the second to fourth segments of the sacral medulla, the examination must be carried out around this segment. ”

"The lower centers innervating urinary and urinary activity are in the sacral medulla 2-4, and the higher centers are in the parietal lobe near the precentral gyrus."

"The problem you just mentioned, in fact, involves the problem I talked about in the general theory of neurology, that is, the problem of irritating and destructive lesions."

"The high-level center of defecation and defecation control mainly governs the person's conscious control over urine and urine. Once this area is damaged, or the conduction tracts below this area are destroyed, the patient will become incontinent. ”

"In the case of this patient, in the 2-4 segments of the patient's sacral medulla, it is actually a destructive lesion."

"The devastating lesions, which manifest themselves in the patient's typical 'saddle' sensory deficits, conform to the anatomical distribution of lesions in this segment."