Epilepsy is often an excessive, synchronized abnormal discharge of neurons in the brain. Electroencephalogram (EEG) can confirm the diagnosis based on the presence of spikes, sharp waves, spike waves, or sharp and slow complex waves.

Moreover, it can provide a certain diagnostic basis for doctors to judge the type of seizure and the location of abnormal discharge.

Zhou Can stared at the patient's EEG and examined it carefully.

It is even compared with the EEG done by the patient before admission.

Soon, he noticed a significant difference in the peaks of the two EEGs.

The spike part is unusually much faster.

In addition, there is a significant increase in scattered abnormal waves on the second EEG.

"Xiao Zhou, tell me about your diagnosis!"

Director Wen may also want to touch Zhou Can's bottom.

He wanted to see what the doctor was doing other than the implantation.

The focus of other people's eyes also converged on Zhou Can's face.

"I'm just a rookie, so let's not express my opinion! lest you laugh at it. ”

Zhou Can had just entered Director Wen's medical team, and he felt that it was better to keep a low profile.

If you say too much, you will lose, this is the way of life and things that his parents taught him since he was a child.

"Say, don't worry, don't worry!"

Director Wen insisted that he speak.

Such a good opportunity to find out, how can you let it go so easily.

This kind of difficult case analysis can test a person's comprehensive diagnostic ability.

"Then I'll be ugly."

Zhou Can is no longer hiding.

"I compared the pre-operative and post-operative EEGs, and there was a big difference. Both the speed of the sharp waves and the number of scattered abnormal waves are much higher than before the operation. ”

After hearing this, Director Wen nodded slightly.

It is not bad that a regular trainee can find so many anomalies in a very short period of time.

"Go on!"

He gestured to Zhou Can.

"Judging from the before and after comparison of the EEG, the surgery not only failed to solve the problem, but made the condition worse."

As soon as Zhou Can said this, the entire office instantly became extremely quiet.

Many people looked at him in amazement.

This trainee is really young, what can he say and what he can't say, don't he have a B number in his heart?

Can you say this kind of scolding Director Wen for not doing a good job in the operation?

Director Wen originally had a smile on his face, but his smile was rigid at the moment.

Although he was not angry yet, everyone could already feel that there was anger burning in Director Wen's heart.

didn't immediately slap the table and scold Zhou Can, but because of his identity.

"Go on!"

Director Wen's tone had obviously become much colder, and his bite was extremely heavy.

Looking at Zhou Can's gaze, it was cold.

A person who does not know how to respect senior doctors is not worth cultivating.

No matter how strong the ability is, it is useless.

"Let's look at the comparison of brain CT scans before and after surgery. Obviously, the surgery has completely removed the original lesion. IMHO, this kind of deformed venous vascular removal close to the internal capsule can be done so thoroughly, and does not cause any damage to the patient's internal capsule, which is no longer a level that the average chief physician can have. ”

"At least that's something that only expert neurosurgeons can do."

Zhou Can first suppressed and then raised.

In just a few words, it triggered a round of warm applause.

Director Wen's somewhat gloomy face instantly became bright, and when he looked at Zhou Can, his eyes were smiling again. And it's a little thicker than before.

His whole person is like a hot June day, and it is more comfortable to drink a glass of rock sugar water.

I have to say that the trick of suppressing first and then promoting is much better than directly praising the other party.

Zhou Can didn't actually think about patting Director Wen's sycophants.

It's just telling the truth.

Maybe even he didn't expect to get the unexpected effect.

Emotional intelligence is very important to cultivate from an early age.

Slowly implanted into the bones, it is difficult to capsize when talking and doing things.

At least Zhou Can has encountered many crises since he entered Tuya Hospital, and they have all been successfully resolved by his high emotional intelligence.

Whether it is Vice President Bai or Shangguan Yan of the Second Affiliated Hospital of Tuya, they have turned enemies into friends with him and are grateful to him.

If it were handled by someone else, it would probably be a different result.

"Haha, the difficulty of this operation is indeed not small, but you said that it can be completed by at least an expert-level surgeon, which is a bit exaggerated!" Director Wen is not without a city government.

It's just that under Zhou Can's first suppression and then promotion, no matter how deep the city is, it is not as happy as Canman's innocent laughter.

Because he was really happy.

It was like drinking honey in my heart.

After complications from this operation, Director Wen's heart was under great pressure. I am even more worried about being ridiculed for not doing a good job.

Now, Zhou Can has said a fair word for him, and even said the highlights and key difficulties of this operation in public.

Did you say that he would not be happy to hear it?

This is not only a recognition of his surgical ability, but also a high praise for Director Wen's best surgical field.

It's much more real than some people's braggadocio touting.

"I'm not exaggerating. Resection of malformed veins near the internal capsule is second only to surgery near the brainstem. Many chief physicians outside the gods did not dare to perform this kind of surgery. There are even fewer who can do it well. ”

Zhou Can continued to praise Director Wen.

Director Wen's name was not mentioned once during the whole process.

But Director Wen was extremely useful when he heard it.

So, patting on the back is really a technical job. It's not a simple compliment to the other party, you are so handsome, you are so capable, you are really rich......

The most clever sycophant is to enter the other party's heart.

Get the deep recognition of the other party.

"Based on the abnormal points of the postoperative EEG and the results of the CT scan, I think there are only two possibilities for the patient to have an aggravation of epilepsy. The first, cerebral hematoma. Second, there are other lesions that go undetected. ”

Cerebrovascular malformations are often not single, but multiple.

Doctors with experienced diagnosis and treatment often ask to start with the patient's neck arteries and veins and go up.

"That's a great point!"

Director Wen's opinion on Zhou Can's diagnosis is admired from the bottom of his heart.

If Dr. Zou or Dr. Tang Li had made this diagnosis, he would not have felt anything.

Because they are all experienced attending doctors.

Don't look at the poor interventional surgery ability of the two, but their academic and diagnostic skills are not bad.

Among the attending doctors outside the gods, they can even rank at the forefront.

It is truly remarkable that a doctor can have such a brilliant diagnostic ability.

"Doctor Zhou, I really didn't see it, not only did you do a good job in implantation surgery, but your level of pathological diagnosis is far beyond me. The three of us will have to learn more from you in the future. ”

The three graduate students smiled at Zhou Can in unison.

This is a gesture of goodwill.

"It's really good to be able to identify two causes. However, in order to cure the patient's epilepsy, it is necessary to lock in the final lesion. Can Dr. Chow make a more accurate diagnosis? ”

Dr. Zou smiled and hid a knife.

It is not easy for a trainee to diagnose the approximate cause.

also wants Zhou Can to answer more precisely, isn't this forcing people to look foreign?

As the attending doctor, he was suppressed by Zhou Can in the operating room. Now the consultation and discussion in the group has been stolen by Zhou Can again.

Dr. Chow inevitably had some unfriendly thoughts.

Suppressing newcomers has always been the most enthusiastic thing for all old people to do.

"I'm just a little learned, and my diagnosis and treatment experience can't compare to you old-timers. Don't dare to make assumptions. ”

Zhou Can saw the move, and with two fluttering words, he pushed the other party's persecution clean.

Then the conversation changed.

Dr. Zou must have already had the answer. It's better to share it and let those of us who are just starting out in the industry learn well. ”

He in turn commanded Dr. Zou's army.

Dr. Zou's status is much higher than him, and there is really no way to get rid of it as easily as him.

"Uh...... Well, this one! Personally, I think there is a greater possibility of vascular lesions at other sites. ”

Dr. Zou stammered, indicating that he was not well prepared.

There is certainly no precise diagnosis in mind.

Now I can only give a vague answer.

"Dr. Zou, I heard that looking at the EEG can determine the approximate lesion area. Can you tell us where the blood vessels are diseased? And then is the degree of the lesion severe? ”

A graduate student asked.

This buddy definitely didn't mean to help Zhou Can deal with Dr. Zou together.

It is purely driven by a strong desire to learn that I have this question.

"Hmm...... Well...... Personally, I think it should be close to this position of the thalamus! As for whether the vascular lesion is serious, everything is subject to the results of the examination. ”

Dr. Zou's answer was a serious lack of confidence.

And it's still ambiguous, not exact.

If you want to give surgery to the patient, this diagnosis is not useful at all.

The location of the lesion is not clear, the lesion is not clear, and almost all of it is guessed. Is that an indication for surgery?

"The lesion is located in the thalamus, which can be basically ruled out. In my experience, the vascular lesions that cause epilepsy have not appeared in the thalamus. The thalamus is more of an endocrine organ. It is pathological, often causing only systemic endocrine disorders or major changes. ”

Director Wen directly shot Dr. Zou's diagnosis.

There was no room for anything.

Medicine is inherently rigorous, prudent, and there is no ambiguity.

"Let's focus on the cerebral angiography done by the patient before the operation. See if you can find out where the lesion is. Of course, the postoperative hematoma mentioned by Dr. Zhou is also very likely, and the postoperative CT scan can also be repeatedly checked and scrutinized. ”

Director Wen gave everyone a general direction.

However, the specific location and cause of the lesion have not yet been determined.

Everyone, you say a word, I discuss it word by word.

Speak your mind.

While studying the films taken by the patient, Zhou Can carefully recalled the specific symptoms of the patient and various manifestations.

Eventually, he came to a startling conclusion.

"Director Wen, do you think it is possible for the patient to have a cavernous hemangioma?"

Zhou Can raised his head and asked.

"Not excluded!"

Director Wen is not an immortal, at best, he has more experience in diagnosis than them, and he has more profound medical knowledge in cerebrovascular and cranial nerves.

"Cavernous hemangiomas are recessive vascular diseases that are difficult to detect even with CT or even the most advanced digital subtraction angiography. In order to do this, I felt the need to request a head MRI for the patient. ”

Zhou Can believes that the possibility of cavernous hemangioma is very high.

On the contrary, intracerebral angiovenous aneurysms can be basically ruled out.

If there really is an arteriovenous vein aneurysm, no matter how small it is, it should have been detected long ago.

"The hospital's MRI resources are quite tight, and the cost of the examination is quite high, can the family accept it?" Tang Li asked with some concern. "During the ward rounds, the family members of the 22-bed patients were very difficult to speak. Now the patient's condition has not been alleviated after surgery, but the epilepsy has worsened, and it is a bit far-fetched to explain it with a postoperative complication. Our families are also extremely distrustful of us. ”

Her concerns were rightly founded.

The doctor-patient relationship is already highly strained.

Especially after this crisis of mistrust, the situation is even worse.

Moreover, the patient has already done two post-operative examinations, and now he has to do an expensive head MRI, and the family may really dismantle the ward.

"We doctors are not immortals. The patient's diseased veins have indeed been cleared by us. Now there are only two reasons for the worsening of epilepsy, either a hematoma or other vascular lesions. So many examinations have been done, and after repeated discussions before the operation, ordinary vascular lesions cannot be hidden at all. Only cavernous hemangiomas, known as silent vascular lesions, are most likely to occur. ”

"If you want to treat the patient further, you can't get around this threshold. To be honest, if there is a postoperative hematoma, a CT scan would have detected it a long time ago. However, CT was done after surgery, and no hematoma was found. So, I think it's important to do an MRI. ”

Compared to CT scans, MRI results are clearer and more accurate.

At that time, it was the advent of MRI that made many tumor diseases easily diagnosed by doctors.

It has unique advantages that ultrasound, X-ray, and CT do not have.

Director Wen bowed his head in contemplation.

As the chief physician, he must have his own thinking.

Zhou Can's opinion is more of a reference.

The doctors in the group will continue the discussion.

Slowly, there is more and more agreement with the idea of doing MRI.

The method of elimination was adopted.

Eliminate some possible scenarios one by one.

Eventually, it was thought that the possibility of cavernous hemangioma was high.

Because cavernous hemangioma has a property, it has ultra-thin blood vessel walls. When you do surgery, there is a real possibility that it will rupture and bleed.

Checking the head can also have a certain diagnostic significance.

It's just that the family members have made such a fuss.

Every request for a test prescribed by a doctor is done with care.

Otherwise, the family will think that the doctor is deliberately making money, not to mention that the operation is ineffective, and ask the patient to do all the examinations again after the operation.

"After careful consideration, I decided to request a head MRI for the patient. Tang Li, your communication skills have always been good, and you have a strong affinity. Is it okay for you to communicate with the family? ”

A medical team should have everyone.

It is also important to maintain good communication with family members.

"Okay, I'll talk to the family right away."

She readily agreed, and seemed quite confident.

Female doctors and nurses have a natural advantage when communicating with their families.

It is more acceptable to family members.

It's also softer.

"Just be open and honest. Tell the family members about the results of the discussion, so that they can understand that the patient's epilepsy is worsening and there is indeed a possibility of double lesions. ”

Director Wen gave guidance.

There are many more complex diseases that are prone to double lesions.

For example, if a mouse is found in the house, it means that there may be more rats in the whole community.

……

Half an hour later, Tang Li communicated with the family and came back.

Her face looked relaxed, and there was even a faint smile.

The explanation is not bad.

"The family has agreed to have an MRI examination, and after communication, their trust in us has also increased a lot. Now I hope I can really find the lesion! ”

Her biggest concern was that she had done an MRI and still had no results.

When the time comes, the trust that has been re-established will be completely lost.

Families will no longer have any trust in the hospital.

After a long wait, the good news came again.

The patient underwent an MRI of the head and found a large vascular abnormality in the cranium.

The doctors in the medical technology department are not weak in their ability to watch films.

They are able to pinpoint the problem with relative precision.

Mark the size of the lesion area, the nature of the lesion, etc.

Director Wen couldn't wait to take the MRI sheet and look at the light carefully.

Little by little, an excited smile appeared on his face.

"Good, great! Sure enough, it was a cavernous hemangioma. This harmful East XZ is really deep enough! almost ruined the old man's reputation. He was so happy that he even used the word old man.

The doctors under him couldn't help but laugh.

"Xiao Zhou, the performance is very good. Seriously, I wouldn't have been able to make up my mind if it weren't for your rigorous analysis and insistence on having a head MRI on the patient. Our group officially invites you to join, and I will apply for you to open an in-group account, so that you can view the cases in the group at any time in the future. If you have a good diagnosis, you can also give me feedback at any time. ”

It is not easy for Director Wen, a person who wants to save face, to give Zhou Can a high degree of affirmation in public.

(End of chapter)