Start From Emergency Doctor

Chapter 256

Zhou Yuan’s expression also became serious in an instant.

He Jianyi: “The director of brain surgery performed an electroencephalogram and cerebrovascular angiography examination when he performed the brain surgery…”

With that, He Jianyi stood up and gave Zhou Yuan five or six films on his desk, “Let’s see for yourself…”

Zhou Yuan took the film and observed it.

“The EEG… the middle temporal gyrus is abnormal?” Zhou Yuan was taken aback.

Duan Hongwei’s electroencephalogram is dominated by medium-to-high amplitude, continuous delta and theta waves, and is confined to the middle of the temporal lobe, and the right side of the brain is obviously dominant.

Moreover, there is an increase in slow waves on the right side, accompanied by a wide range of moderate rhythm disorders… This is the EEG of patients with cerebral hemorrhage!

“Duan Hongwei had cerebral hemorrhage when the accident happened?!”

Zhou Yuan’s expression is a bit complicated.

Once it is confirmed that Duan Hongwei’s accident was caused by illness, I am afraid that Duan Hongwei may have escaped when the court sends a sentence and convicts him.

Worrying that Duan Hongwei will not be punished by law is one aspect. In addition, if doctors like him really give the heinous Duan 26 Hongwei a disease certificate, those crazy family members will come to find trouble…

Zhou Yuan kept watching.

An EEG alone cannot prove anything.

Cerebral angiography is the key to diagnosis.

“There are severe stenosis in the upper clinoid process of the bilateral internal carotid arteries and the proximal anterior and middle cerebral arteries…”

Zhou Yuan’s voice is a little low.

The patient had a stenosis in the first segment of the neck of the siphon of the internal carotid artery, and the stenosis extended to the second segment of the neck.

Cerebral angiography on both sides is basically the same, but asymmetrical. The stenosis starts from the right side. So far, there is no vascular stenosis on the left side. The front half of the circle of Willis is involved, basal ganglia, thalamus, hypothalamus, brainstem, etc Most of the perforating arteries at the base of the brain also have stenosis, and some of the main cerebral blood vessels have formed abnormal vascular compensatory collateral circulation at the base of the brain…(Read more @ wuxiax.com)

At the same time, angiography also showed that there is a significant telangiectasia network at the basal ganglia, forming a collateral circulation centered on the internal and external striatal arteries and thalamic arteries, thalamic geniculate arteries, and front and back choroidal arteries.

Zhou Yuan frowned.

“It’s not just a brain hemorrhage…”

He probably had a guess in his heart, then looked at He Jianyi, and said, “Teacher, are there any CT scan images?”

He Jianyi nodded heavily, then handed the CT image on the table to Zhou Yuan, saying: “We are the same as your guess…”

Zhou Yuan looked at the CT image.

Duan Hongwei’s CT image shows no multiple cerebral infarctions, and no secondary brain atrophy…

Generally speaking, the more severe the internal carotid artery stenosis and the worse the blood supply, the more obvious brain atrophy, but people with better collateral circulation will not see brain atrophy on CT.

Therefore, the collateral circulation is a double-edged sword in medicine. When the main blood vessels cannot transport blood normally due to thrombosis, stenosis, occlusion, etc., the collateral circulation can ensure blood supply through other blood vessels.

But…because of the compensatory effect of collateral circulation, it is difficult for ordinary people to find out that their blood vessels have problems, and they don’t know that they are suffering from major diseases.

“The patient’s ventricles are enlarged and accompanied by intracranial hemorrhage… Teacher, is Duan Hongwei subarachnoid hemorrhage?” Zhou Yuan asked the last question.

He Jian nodded

The two looked at each other and said at the same time: “Moyamoya disease.”

More than half of patients with moyamoya disease will develop ventricular enlargement, the enlarged ventricle is just on the same side of the lesion, and a few right ventricles are enlarged. About 60% to 80% of patients with moyamoya disease will have intracranial hemorrhage, especially subarachnoid hemorrhage.

Enlarged ventricles and intracranial subarachnoid hemorrhage, the two together, can basically determine that Duan Hongwei is suffering from moyamoya disease.

Moyamoya disease is an unexplained disease. The main feature is chronic progressive stenosis or even occlusion at the ends of the internal carotid arteries and the beginning of the anterior cerebral artery and middle cerebral artery. Abnormal blood vessels at the bottom are a kind of cerebrovascular disease.

It is called moyamoya disease because this kind of abnormal blood vessel network at the base of the skull looks like a cloud of smoke on the cerebrovascular angiography image. The small blood vessel network is narrowed and blocked, which makes the cerebrovascular angiogram look very Confusing and difficult to distinguish.

There are four main types of this disease, namely four main clinical manifestations.

Transient ischemic attacks are the most common, accounting for about 70% of moyamoya disease patients. They are characterized by hemiplegia, that is, one limb is completely paralyzed. Some patients with moyamoya disease are more serious, with alternating left and right hemiplegia. The left limb cannot move for a while, and the right limb cannot move for a while.

Moyamoya disease caused by transient cerebral ischemia is mostly benign. It has a tendency to spontaneously relieve the fire attack and stop completely, and it will not cause any impact on the body after the attack.

There are also infarcts, which can cause acute strokes, namely strokes, accompanied by persistent paralysis, aphasia, visual impairment and even mental retardation.

The epilepsy type is mainly frequent occurrence of epilepsy, and hemorrhagic type, which is manifested as intracranial hemorrhage, mainly subarachnoid hemorrhage.

Duan Hongwei’s Moyamoya disease is likely to be between the first and fourth types-transient cerebral ischemia and intracranial hemorrhage.

“There is no warning before the onset of moyamoya disease. Although there is stenosis, there will be collateral circulation to compensate for blood supply soon, and occasionally dizziness, but…no one will specifically do a cerebrovascular angiography…” Zhou Yuan With his head down, it was basically concluded that Duan Hongwei was suffering from moyamoya disease.

This is a very rare cerebrovascular disease. There is currently no effective drug for moyamoya disease in the world. However, for some patients with chronic moyamoya disease, some dilated blood vessels may be beneficial to resist vascular stenosis, anti-platelet aggregation and anticoagulants.

In country R in 2012, the national medical community proposed oral anti-platelet aggregation drugs to treat ischemic moyamoya disease, but it lacked sufficient clinical evidence, and it was later discovered that long-term use of anti-platelet aggregation drugs, such as aspirin, not only It will not make the condition improve, but will also transform ischemic moyamoya disease into hemorrhagic moyamoya disease…

Drugs do not work, and surgical treatments are also helpless.

Although the medical community proposes to perform intracranial and extracranial vascular reconstruction surgery, it is true according to theory. Since the vascular network is entangled and stenosis occurs, the blood vessels should be dredged, reset, and reconstructed.

However, the theory is only a theory, just like Zhou Yuan’s finger reconstruction surgery. Which country, country R or country M, has never thought that a toe with a similar shape can be transplanted into a finger? But in the end, only Zhou Yuan succeeded in practice.

And this time, Zhou Yuan has become the father of reinvented fingers.

The same is true for moyamoya disease. .