This doctor has a system

Chapter 578 641. Stiff Man Syndrome

Here, Sun Zhengming was carefully inquiring about the patient's condition. He decided to show off in front of the department director, so there must be no omissions in the medical history.

After asking the patient, he began to ask the patient's husband, and then the patient's son. The three of them confirmed each other's information to avoid missing anything.

"Why does it feel like interrogating a criminal?" the patient's son muttered.

"They are responsible for your mother," the patient's husband said, "you better tell the truth!"

"The disease is more likely to occur when there is sound or light stimulation?" Sun Zhengming raised his head.

“Yes,” the patient replied.

It can’t be rabies, right?
After thinking about it, Sun Zhengming felt that it was unlikely. First of all, the patient had not been bitten by a mad dog. Secondly, after the onset of rabies, the grass on the patient's grave should have been 2 meters high. It was impossible for her to live that long.

In short, after all the inquiries, the useful information obtained was basically zero.

Sun Zhengming did not feel frustrated. If the disease could be diagnosed so easily, the patient would not have spent two years seeking medical treatment and medicine.

"Zhengming, what disease do you think she has?" Gao Feng asked.

"Hereditary spastic paraplegia?" Sun Zhengming asked, "But the symptoms don't seem to fit."

Hereditary spastic paraplegia is mainly manifested by spasticity of the lower limbs, which generally does not involve the trunk muscles. This patient obviously does not fit the criteria, but the symptoms of some diseases are not very typical, and patients will not get sick according to the guidelines and textbooks.

So Sun Zhengming’s guess is not necessarily wrong.

"Actually, I also thought of tetanus." Sun Zhengming spoke out all the thoughts in his mind.

Tetanus is an acute infectious, toxic disease caused by Clostridium tetani. After invading the human body through the skin or mucous membranes, Clostridium tetani reproduces and secretes toxins in an oxygen-deficient environment, causing persistent rigidity and paroxysmal spasms of skeletal muscles throughout the body.

Simply put, the muscles are so stiff that they cannot move on their own. Severe patients may experience suffocation and respiratory failure, and even death.

This disease may cause local muscle tension or hyperreflexia for a period of time after recovery.

However, Sun Zhengming did not ask the patient about her history of skin puncture by foreign objects, and another thing is that tetanus causes sensitivity to the masseter muscles, and often causes trismus. The patient and her family were very sure that she had no relevant clinical manifestations.

"So what should we do next?" Sun Zhengming asked.

In response to this question, Gao Feng only said one word: check.

Keep checking, keep checking, and check everything that can be checked.

This is the first patient of the Center for Rare Disease Medicine, and we must make sure she is treated properly.

"Expensive examinations will pose a huge challenge to patients' poor financial situation, and they certainly won't be able to afford it," Sun Zhengming said after a moment of hesitation.

What else can we do?
Work at your own expense.

In a word: Mr. Gao will pay for this consumption.

"If that's what you say, then I'll start." Sun Zhengming was eager to try, so in the next week, he completed a muscle biopsy for the patient: normal;
Electroencephalogram: normal.

Cerebrospinal fluid examination: normal cell count, no increase in protein, immunoglobulin IgG, IgA, and IgM.

MRI of the head: transient inflammatory changes in the brainstem. Electromyography: The resting potential is a continuous normal action potential, which suddenly increases during the spontaneous spasm period after somatic sensory stimulation or passive movement. The electromyographic activity is significantly weakened or disappears after falling asleep or intravenous injection of diazepam, general or spinal anesthesia, nofloxacin or curare blockade, and chewing increases.

Immunological indicators: anti-glutamic acid decarboxylase antibodies are positive.

Most patients do not like to have examinations, and some even have violent arguments with doctors over this in outpatient clinics.

But if all these simple things were free, that would be a different story. The patient's cooperation was very high.

Gao Feng was very satisfied with Sun Zhengming's performance. After all, he was a doctor and his abilities were there. Some doctors had nothing in their heads, and they couldn't find the direction even if you asked them to spend a lot of money.

"Zhengming, the results are out, do you have any ideas?"

"No." Sun Zhengming was a little embarrassed. In fact, a lot of ideas emerged in his mind during this period, but as the inspection was completed step by step, these ideas disappeared completely.

"Have you gone back to read the literature?" Gao Feng asked.

"I've read some, but I feel like none of them match up." Sun Zhengming answered honestly. He briefly talked about the rare case reports he had seen in the past few days.

"You have put in a lot of effort." Gao Feng was very happy. He was very satisfied with the performance of the only junior doctor in the current Rare Disease Medical Center.

Seeing his relaxed look, Sun Zhengming couldn't help but guess: "Director, could it be you..."

"Yes." Gao Feng did not keep the secret any longer, "The patient should be suffering from Stiff-Person Syndrome."

Stiff-person syndrome is a rare, severe central nervous system disorder characterized by excessive contraction of the trunk and lower limb muscles, accompanied by myalgic muscle cramps.

Multiple high-titer autoantibodies can be detected in patients, accompanied by other autoimmune diseases. Common clinical manifestations include persistent or fluctuating stiffness of the trunk, limbs and neck muscles, board-like firmness of the abdominal muscles, and both agonist and antagonist muscles being affected at the same time.

The cause of this disease may be related to genetics, neurophysiology, immune response, etc.

The system played a role in more than 80% of Gao Feng's ability to make this diagnosis. You can never imagine what it would be like to have an intelligent computer in your mind.

“The patient has the following four characteristics:

1. The patient had a history of more than 2 years, with a chronic onset. During attacks, he had typical symptoms of increased axial muscle tension, including persistent stiffness and rigidity of the facial muscles and masticatory muscles, which were "board-like". The symptoms were easily induced by emotional tension and light stimulation, and there was excessive anterior concavity of the lumbar spine.

2. Electromyography shows that, in a quiet state, the agonist and antagonist muscles of the lower limbs have synchronous and continuous motor unit potential activity, and the electromyography resting potential can have normal action potential release. During an attack, the electromyography release is enhanced, and the potential release is weakened or disappears after the injection of diazepam;
3. Anti-glutamic acid decarboxylase antibodies are positive, which is crucial.

4. The patient has been treated with clonazepam in the past two days, and his symptoms have been alleviated. "

As these items were listed one by one, Sun Zhengming was full of admiration. Being able to come up with such valid information from so many tests and examinations really tests a person's medical skills. You must first have a basic understanding of the disease, which he certainly could not do.

"Have you studied this disease before?" He realized his stupidity after asking this question. It was obviously impossible.

"Your inspection played a crucial role." Gao Feng praised him.

“Zombie syndrome?” The patient shuddered. “I haven’t been bitten by anything dirty!”

"It's Stiff-Person Syndrome," Sun Zhengming explained. "It's a relatively rare disease.

(End of this chapter)