Judging from the symptoms of Tang Min, who is named Nannan, Sun Lien's current suspicions are in two main directions.

First, it may be a genetic disorder. From the perspective of the age of onset, children are definitely the group with a high incidence of genetic diseases. And the widespread presence of lesions in the nervous system also seems to suggest that the areas of these lesions share some degree of common features.

Second, if it is not a genetic disease, then it may be some kind of malignant tumor that is widespread in Tang Min's central nervous system. From the perspective of invasion of the optic nerve and extensive mass lesions in the brain, it may be ...... to combine the point of mild glial hyperplasia It is a tumor that is present in the brain at the same time, but is still in the early stage of the disease.

But both hypotheses are currently very fragile and untenable. If it is a genetic disease, then it seems that the current lesion area should be more extensive - and Sun Lien cannot find a reasonable logic to explain why Tang Min is sick at this point in time.

If it's a tumor, the two brain biopsies didn't detect cancer cells, which is very unscientific — this is not the time when doctors thought pheochromocytomas would only appear in the adrenal glands. In the case of imaging to confirm the mass lesion, and the biopsy was sampled by a high-precision neurosurgical robot, no cancer cells were found twice in a row...... It's a fantasy.

Most researchers engaged in scientific research need the basic mentality of "bold assumptions and careful verification". But Sun Lien's problem now is that in the face of a pile of obvious evidence, he can't put forward anything that can be called a "hypothesis". With the current strength of the evidence, whether it is a genetic disease or a tumor suspicion, it is more like a dream than a hypothesis.

There's a lot of evidence to add and a lot to improve. But these questions can be relied on first. After Sun Lien pondered for a while, he decided to treat Tang Min with intracranial decompression first.

Cerebellar tonsillar herniation is a life-threatening condition. Even though it has lasted for thousands of hours, it is still a problem that cannot be ignored. Anyway, there is no new progress in the diagnosis for the time being, so it is good to control the intracranial pressure first and improve Tang Min's brain tissue compression - at least there will be no serious side effects.

Of course, controlling intracranial pressure requires some indications first. And this indication was quickly manifested under CT.

"Type I cerebellar tonsillar herniation. The imaging department immediately noticed the problem and raised it to Sun Lien, who was in charge of escorting the examination, "The situation is not too serious - the cerebellar tonsils enter the greater foramen of the occipital bone about 6 mm, and the fourth ventricle and medulla oblongata are slightly elongated. ”

"Got it. Sun Lien nodded, and then asked, "Do you have any other questions?"

"The others are not available for the time being. The radiology doctor looked at the CT results again and said, "Uh...... Her optic nerve is a little meandering and may need an optic nerve potential map to clarify its nature. ”

The doctor in the imaging department has already performed at a super level, Sun Lien took out his notebook and wrote it down, and asked Zhou Ce on the side to continue to follow the examination, while he returned to the office and began to give medical orders.

125 ml mannitol intravenous infusion...... When he wrote this, Sun Lien still felt a little kind. Since entering the comprehensive diagnostic center, he has been using mannitol less and less. While reminiscing about the "stormy" emergency life in the past, Sun Lien wrote the doctor's order. Then he thought about it and called Qian Hongjun.

"Director Qian, I have a patient here, and the situation is more complicated......" Sun Lien didn't ask him if it was inconvenient to speak now after Qian Hongjun answered the phone. After quickly describing the basic situation in relatively short language, he asked, "Although her cerebellar tonsillar herniation has not caused any serious consequences, I still think it is better to control the intracranial pressure first - is 125ml enough?"

Adults with cerebellar tonsillar herniation usually use 250ml of mannitol. In addition, after controlling intracranial pressure and preventing herniation tissue from compressing the medulla oblongata and brainstem, surgery should be performed as soon as possible to relieve the cause of elevated intracranial pressure. But...... In fact, Tang Min is only seven years old, and she has no cause of increased intracranial pressure that can be surgically solved - what this cause is still a mystery.

There is a dilemma, and there is no suitable solution to this dilemma. In addition to using mannitol first, Sun Lien really didn't have any particularly suitable means to deal with it. Moreover, looking at the appearance of Tang Min's parents, Sun Lien felt that he had to do something first to make them feel a little more at ease.

Treatment is a very complex process. In addition to treating the patient, sometimes the patient's family members are also treated.

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Yuan Ping'an has not been idle since he got Sun Lien's instructions at noon. He first called his teacher Zhu Minhua in the association for help, and then followed Zhu Minhua's instructions and made phone calls for more than an hour in a row, and finally received Tang Min's case from the association.

The PDF file of the case is 174 pages long, and the various imaging and pathology pictures in it are more than 400 trillion in size. According to Sun Lien's requirements, this case must be at least one for the doctors in the diagnosis department to be called appropriate. As a result, Yuan Ping'an, who graduated from the Association with a master's degree in neurosurgery and a doctor in the emergency department, became Yuan's secretary who was running around in the office. There are a total of three printers in the offices of the two diagnostic groups. After working for two hours, all three machines were declared "exhausted".

After calling the General Affairs Office to ask for a replacement, Yuan Ping'an looked at the four medical records that had just been printed out in his hand, and then resolutely decided to take the USB flash drive to the flash printing shop outside to complete the rest of the work.

Yuan Ping'an knows better than Sun Lien how strong the neurology department of Tongxie is. Although he has full confidence in his team leader, Yuan Ping'an still believes that this patient is definitely a tricky case.

He had never seen Sun Lien handle a single case so like a great enemy. In the past, Sun Lien first went to see the patient, and after collecting the medical history, he arranged the examination according to the basis. Based on Yuan Ping'an's observation, as long as Sun Lien put forward a request for examination, it can basically be determined that he has a very reliable diagnosis direction.

But this time the situation is different. Sun Lien basically did all the tests that could be done in one go. Of course, this move can be understood as Takeda Pharmaceutical's indeed a particularly wealthy man. But Yuan Ping'an still felt ...... Sun Lien was a little flustered.

It's not uncommon for panic to happen to doctors. But it's very rare for it to happen to Sun Lien - this guy used to be confident and lightweight.

With a trace of sympathy for Sun Lien in his heart, Yuan Ping'an put on a doctor, pushed open the door of the office and walked out. As a result, as soon as I went out, I collided with the person outside the door. Yuan Ping'an covered his sore nose, and it took a long time to change in. He glared and was about to complain that the other party was walking too carelessly, but when he saw the visitor, he suddenly forgot that the pain on his nose was unbearable.

"Dr. Xu, are you back?"