This should not be a reaction caused by an overdose.

Doctors from the Department of Anesthesiology came to consult at Zhou Ce's request. After some simple stimulation checks, the anesthesiologists gave their opinion, "It's not a coma caused by a drug overdose. ”

In fact, from the dosage alone, the doctors in the anesthesiology department can make such a judgment. But there is always something unusual about the human body, and maybe there are people who are not in the same state as ordinary people - they really have an overdose because of two milliliters of diazepam injection.

In order to rule this out, the doctors in the anesthesiology department moved out the EEG analyzer to examine Cao Zhiquan. The results of the examination fully confirmed the judgment of the anesthesiologists - Cao Zhiquan's EEG (electroencephalogram) showed a typical three-phase wave structure.

"We are not gods, and EEG is not as professional as others. When Sun Lien arrived in the ward, the anesthesiology doctor was explaining his findings to Zhou Ce, "But drug overdose doesn't cause triphasic waves—this thing usually only occurs in patients with metabolic encephalopathy, Alzheimer's disease, encephalitis, or drug-toxic encephalopathy." ”

"Three-phase waves?" Sun Lien greeted the anesthesiologist in the room, and nodded to Zhou Ce, who looked a little anxious, before taking the EEG and looking at it.

To clinicians, EEG is a seemingly boring and confusing pattern – a large number of seemingly irregular and disorganized waveforms that are not only incomprehensible to patients, but also not to doctors in related departments.

Sun Lien is between "I don't understand much" and "I don't understand too much". EEG is a very frequent material when training old stuff. So even with Sun Lien, I can't see less. He has some knowledge of this as an important tool for clinical analysis of patients with impaired consciousness.

"The waveform is no problem, it is indeed a three-phase wave...... Sun Lien looked at this EEG, and found the location of the three-phase wave in the chaotic and complicated graphics that can even be called "chaos". The waveform is quite typical, but you still have to look for it carefully.

"Did you check his liver function?" Sun Lien also thought of metabolic encephalopathy first. Moreover, metabolic encephalopathy is also consistent with the symptomatic suggestion of hyperintensity on diffusion-weighted imaging of the whole cerebral cortex. Among the metabolic encephalopathy, Sun Lien is most familiar with hepatic encephalopathy. Hence the question.

"The nurse hasn't come to draw blood yet. Zhou Ce shook his head and added, "I also took a kidney function and blood sugar test at the same time...... If it's metabolic encephalopathy, you have to look at these together. ”

Zhou Ce's consideration is a serious move by Lao Cheng, and Sun Lien will naturally not object. While nodding his head, he began to observe Cao Zhiquan's status bar again - when he was first admitted to the hospital, Cao Zhiquan's state would definitely be very different from his current loadout. If you can find the cause of the change by the difference between the two status bars, it may be helpful in diagnosis.

Cao Zhiquan, male, 44 years old. Hyperintensity on diffusion-weighted imaging of whole cerebral cortex (12833.19.41), subacute dementia (127833.19.41), paroxysmal muscle spasm (1438.39.50), and inactive silence (07.24.51)"

Sure enough, the status bar prompted a new action. But Sun Lien didn't get any valuable information from it—he wasn't a doctor after all. Motionless silence is of course an important hint, and this hint can at least allow Sun Lien to be sure that Cao Zhiquan's coma state really has little to do with diazepam.

But this state ...... What does it have to do with his current symptoms, and what do he have in common with his whole brain lesions, subacute dementia, and paroxysmal muscle spasms?

Sun Lien felt that he had a headache, and this kind of pain was a typical feeling when he used his brain too much.

On an optimistic note, at least the inactive silence will help the diagnostic team to take a few detours. Cao Zhiquan certainly does not have metabolic encephalopathy. Inactive silence is generally present in patients with impairment of the upper reticular activation system of the brainstem and the prefrontal-limbic system. It is usually caused by primary brain tumors, pineal tumors, metastases, and basilar vascular disease. Relatively speaking, this is a very serious symptom.

Sun Lien walked to Cao Zhiquan's side and began to try to wake him up, "Mr. Cao, Mr. Cao?"

This kind of attempt didn't work very well. Cao Zhiquan's eyelids moved slightly, but his eyes were still closed.

Inactive silence, also known as "waking coma" and "hypersomnia", is a condition in which patients have a low level of consciousness and reflexive limb movements in response to stimuli, but lack voluntary movements, self-talk, and emotional responses. Some patients may have spontaneous eye opening, fixation, or even gaze movements.

Since there is little response to sound stimuli...... Then try the haptics.

Sun Lien learned from Zhou Jun's appearance, and pressed Cao Zhiquan's supraorbital notches on both sides with his thumb, and with a little force, Cao Zhiquan really frowned, and moved his hands and feet.

"There is a reflex to pain, and the degree of coma is not very deep. Sun Lien said to Zhou Ce on the side, "This looks a bit like immobile silence." ”

Zhou Ce didn't know much about the content of neurology, so he thought about it and proposed, "I'd better ask for a consultation with Shennei." This patient's condition is a bit beyond my reach. ”

This patient's situation is not only beyond Zhou Ce's ability, but even Sun Lien himself is a little unable to figure it out. After all, Cao Zhiquan had a brain MRI. There are no symptoms other than cerebral atrophy and diffusion-weighted hyperintensity on whole cerebral cortex, and the findings do not support the corresponding basilar vascular lesions and solid brain tumors.

Things have come to this point, and Sun Lien also feels a little difficult to do. If it's just to solve a puzzle, there are plenty of ways to do it. But Cao Zhiquan is not just a "puzzle", he is still a person, a father, and a husband.

If it is just a guinea mouse, then in order to solve the problem, the researchers can even consider dissecting the mouse, and then extracting the brain tissue and grinding it for material analysis, or slicing it for observation. It's just a guinea pig anyway - it's not unacceptable to put a lab animal to death in the face of the need to solve a problem.

But Cao Zhiquan can't.

Even if a sample of brain tissue is taken for biopsy, it will inevitably cause irreparable damage to the brain. Moreover, the damage is highly uncertain. No matter how skilled a neurosurgeon is, there is no guarantee that the brain tissue he extracts will not affect the normal function of the brain. There is no guarantee that the extracted brain tissue can be the last piece of the puzzle for a diagnosed patient.

At the risk of completely or partially incapacitating a family to solve a puzzle, Sun would never do this unless the puzzle was related to the patient's life.

To be a doctor, this level of humanitarianism is a must.

"Please consult with God...... Give him bromocripting and medopa first. Sun Lien thought twice and decided to follow the standard process first. The combination of bromocriptine and medopa is a well-established therapy for patients with severe head injury who exhibit inactive mutism. It should be noted that although this is now the main treatment option, the effectiveness rate is still not satisfactory. The overall response rate of this combination is about 60%, and only 25% of patients are able to regain consciousness and self-care.

For patients with head injuries, the most precious thing is always the time for treatment. The sooner treatment is started, the better the recovery.

Sun Lien looked at Cao Zhiquan lying on the hospital bed, and his mood was a little heavy.

I hope he can still stand up and embrace his life and his loved ones.