I run a clinic in the United States

Chapter 365 Brain leak

However, after more than ten days, Mr. Carlisle's illness not only did not heal, but became more and more serious.

Not to mention getting up, as soon as I sit up or stand up, the pain becomes unbearable within a few minutes and I need to lie down.

This disease that attacks without "lying down" is really a headache!

Although Mr. Carliss has retired long ago, he accumulated enough wealth in his youth to ensure that he will have no worries in his later years. He does not need to go to work at a very old age and can be regarded as "living in peace" for many years.

When Mr. Carliss came for a follow-up visit for the first time, Dr. Rachel understood the condition, pondered for a moment, and suggested another head CT.

Because it was not detected at the initial diagnosis, it may be because the condition is mild, and as the condition progresses for a period of time, the cause may be found.

Sure enough, you wouldn’t know if you didn’t check, but when you checked, you were shocked. The CT showed that there was an inexplicable extra layer of blood on the surface of Mr. Kallis’ brain!

At that time, Dr. Rachel watched the film and fell into deep thought.

The Carliss couple felt anxious and uneasy. I am not afraid that the doctor will make a joke, but I am afraid that the doctor will become serious.

"Dr. Rachel, is my husband's illness serious? What caused it?" Mrs. Carliss asked.

In Zhou Qiao's office, Zhou Qiao looked at the film, asked about the specific symptoms, and said, "This is a low-pressure headache. Mr. Carliss, your head may be leaking."

"Mr. Carliss, don't worry too much. With Dr. Zhou here, we should be able to find out the cause of the disease quickly." Dr. Rachel said apologetically.

I was confused for a while, and it seemed that I had to ask my boss for help.

Dr. Rachel helped them arrange a head CT again.

Rachel said: "Your condition is considered subdural hematoma. Looking at the film, you have been bleeding for a while, and part of it has liquefied. Fortunately, the blood is on the surface of the brain, not inside the brain, and the amount of bleeding is not large. , no surgical intervention is needed, and it may be absorbed slowly by taking some medicine without any sequelae.”

At this time, during the second follow-up visit, Zhou Qiao and Murphy had returned from Northern Europe and had just arrived at Iris Clinic for two days.

After the first follow-up consultation, Dr. Rachel recommended atorvastatin tablets to the patient. In addition to lowering blood lipids, this drug can also promote the absorption of subdural hematoma. According to the patient's condition, the dosage is one tablet per day. And asked Mr. Carlisle to come back for a follow-up CT scan in two weeks.

The Carlisians looked at each other, recalled it carefully, and shook their heads at the same time.

"I have only taken painkillers recently. At other times, because of my headache, I lay down most of the time and did not have the opportunity to go out for activities. Therefore, there was no chance of hitting my head." Mr. Carliss said very suspiciously.

Zhou Qiao said: "After lying down, the water pressure in the brain increases, there is less leakage down there, and the headache is naturally relieved."

Mr. Carliss was still suspicious. What did the leak have to do with my headache? So he asked: "Dr. Zhou, why doesn't it hurt as soon as I lie down?"

Seeing everyone's confusion, Zhou Qiao smiled and explained carefully: "Our human brains are actually immersed in water. Normally, the water is fluid and can maintain a certain pressure. Once the water in the brain When the pressure decreases, people will feel headaches. As for why the water pressure decreases, it may be that there is a place in the lower spine that has been leaking water. The leaked water is absorbed by the tissue and will not leak out of the body. "

"what?"

Rachel thought for a few seconds and asked: "Does Mr. Carliss take aspirin, clopidogrel and other drugs? Or, has he fallen or hit his head in the past month or two?"

Rachel took the patient and the report to Zhou Qiao's office.

Not only were the Carliss and his wife confused, but even Dr. Rachel was slightly stunned. I thought Dr. Zhou was amazing, why didn’t I think of it before?

In fact, this belongs to the category of neurosurgery and is beyond Rachel's ability.

Rachel: "..."

The Carlisses are also full of expectations. They have long heard that Dr. Zhou Qiao of Iris Clinic is young and promising and is a top-notch multidisciplinary medical expert.

Within two weeks, Mr. Carliss, accompanied by his wife, came to see Rachel again because his headache symptoms had not improved at all and they did not want to make it more serious.

As a result, the Carliss couple felt relieved again. As long as it's not serious.

The report showed that the blood on the surface of Mr. Carlisle's brain showed slight signs of absorption, but his symptoms did not alleviate.

Mr. and Mrs. Carlisle and Dr. Rachel suddenly understood and nodded.

Dr. Rachel secretly thought and learned another point of knowledge. How nice would it be if she were decades younger? Then you can learn more from Dr. Zhou. Although it is not too late to learn, after all, the potential is limited.

Look at how quickly Murphy, Stephanie, and Nanako Chiba grew up after studying with Dr. Zhou! How enviable!

Mrs. Carliss asked: "Then the bleeding in my husband's brain is also related to the leakage?"

Zhou Qiao nodded and said: "Of course it does. Reducing the pressure in the brain will induce bleeding. In severe cases, it may even lead to cerebral herniation or whole-brain swelling, which is life-threatening."

"Then what should we do now?" The couple looked at each other, a little anxious. In addition, at such an old age, if surgery is required, I wonder if my body can support it?

There are many people who are older and have had surgery, but after the surgery their bodies collapse and become extremely weak, and then their funerals are held within a few years of their lives.

Mr. Carliss didn't want that.

Although he is already over seventy, he still wants to live for another twenty or thirty years!

If surgery is performed radically, the disease will be cured, but the damage to the body and shortened life span will be totally worthless.

Zhou Qiao comforted him: "It's okay. We'll go to the hospital first and do a myelogram to find out where the leak is. Then we'll just do a minimally invasive surgery to repair it. You must have heard of the specialty of our Iris Clinic. We What I am best at is minimally invasive surgery, not just on the heart, but also on many other surgeries. In a word, we all do minimally invasive surgery if we can do it."

"I've heard of it." The Carliss nodded repeatedly. It is said that Dr. Zhou often creates his own minimally invasive surgeries and publishes them in core journals. News about Iris Clinic is often reported on TV and newspapers.

Moreover, they are not only good at minimally invasive surgeries, but they are also very good at "major" surgeries, such as heart transplants. No, many media in San Francisco were reporting a few days ago, saying that it was the latest news coming from Northern Europe. Doctor Zhou and the cold Miss Murphy performed a heart transplant on the great-aunt of the twin princesses. Operation.

It has to be said that those rich and powerful people enjoy privileges. Even though they are ninety-eight years old, they can still have the young hearts of little girls.

As for ordinary elderly people, how can they have that kind of opportunity? I don’t even dare to think about it.

Zhou Qiao called Park Xiuzhu, took the two of them to the community hospital, and arranged them in the neurosurgery ward to complete a series of routine examinations. Afterwards, Zhou Qiao personally took action and performed a lumbar puncture on Mr. Carlisle. The measured pressure was unexpectedly Up to 250mm water column.

Under normal circumstances, the pressure value of lumbar puncture is between 80-180 mm water column. If the patient's lumbar puncture pressure exceeds this range, it is abnormal. If the patient's lumbar puncture pressure is lower than 80, it is also normal and does not require excessive worry or special treatment.

Lumbar puncture is a clinical operation that extracts cerebrospinal fluid or injects drugs by puncturing the lumbar space. It is not only an important means of diagnosing meningitis, cerebral hemorrhage and other diseases, but also a key step in treatment such as spinal anesthesia. In the eyes of many people, this operation seems to be relatively risky, and just hearing the word makes people feel frightened. However, in fact, lumbar puncture has developed into a relatively safe and accurate operation in modern medicine.

This method is mainly used to diagnose central nervous system diseases, such as encephalitis, meningitis, subarachnoid hemorrhage, cerebral hemorrhage, etc. It can also be used to measure intracranial pressure.

And Zhou Qiao is a "national player" with a perfect level. Performing such a minor surgery is not worth mentioning.

"High pressure will cause head pain. Due to intracranial hemorrhage, your condition has evolved from low intracranial pressure at the beginning to high intracranial pressure now." Zhou Qiao explained to the patient.

Subsequently, after injecting the contrast agent into the spinal canal, Zhou Qiao arranged a thin-section CT of the whole spine for Mr. Kallis.

He is a detached existence in the community hospital, and his needs will be met as soon as possible.

But for other doctors who are also affiliated, this may not be the case.

Soon, the thin-slice CT with a layer thickness of 0.6mm was transmitted to the computer, with a total of more than a thousand films.

Zhou Qiao called Murphy, Stephanie, and Nanako Chiba to consult and discuss together. Several doctors from the neurosurgery department of the community hospital also came to study with him.

This is a rare opportunity.

Everyone sat around a small conference room, projected onto a 55-inch 4K high-definition screen, searching frame by frame for fear of missing any detail.

Murphy was in charge of playing it. After a while, her finger stopped, zoomed in, and said, "This is it."

Sure enough, everyone can see that the contrast agent is well filled in the place shown on the screen, and a small amount of contrast agent can be seen extravasating into the epidural space at the level of chest 5.

Zhou Qiao nodded: "Yes, the leak is definitely here!"

"However, we don't rule out the possibility of leaks in other places." Stephanie said.

So, everyone worked together again, turning over and over, watching more than a thousand films several times, eliminating leaks in other places, and confirmed that there was only one.

After hearing the news, Mr. and Mrs. Carlis finally breathed a sigh of relief, saying that Dr. Zhou and the others were amazing.

This is the advantage of coming to Iris Clinic for medical treatment. Rachel and the others can handle minor ailments. If they really can't handle it, they can always invite the top famous doctors in North America for consultation.

Moreover, the experience in this kind of private clinic is much better than going to a large hospital like the University of California Medical Center. For example, the service is more attentive, arrangements are faster, etc.

Once the leak was found, the surgery began.

This is a super minor surgery.

Local anesthesia, injection, minimally invasive, all done in ten minutes!

"Oh my god, so fast?" After the operation, Mr. Carliss was amazed. Is this done?

Zhou Qiao smiled and said: "Don't be too quick, the technical content is very high!"

"Yes, yes, it's really high!" Mr. and Mrs. Carliss gave a thumbs up in agreement. Being able to cure this strange disease easily, the simpler the method, the more it shows the level of a doctor.

This is the magic of famous doctors.

It's also quite easy to understand. For the same condition, ordinary doctors go through many troubles and drastic measures. Even if the patient is seriously injured and suffers, it may not be cured well.

But other famous doctors give it a shot and call it a day. Make a decision!

"Although this injection is difficult, the principle is very simple." Zhou Qiao thought for a while and gave an analogy, "It's like the science fiction movies we usually see. In the universe, the space suit suddenly leaks air. What should I do?"

"How to do?"

"It's very simple. Just use special tape to tape the air leakage. But to repair the space suit, you need appropriate tape, and to repair the leak in the brain, you also need appropriate tape. This tape is your own blood."

Just now, Zhou Qiao performed surgery to extract 20 ml of venous blood from the patient's body, and while it was still hot (before it coagulated), he slowly injected it into the epidural space near the leak.

In this way, the blood forms a 'copper wall and iron wall' outside the leak.

Over time, the blood will be slowly absorbed by the body, but it will also cause an inflammatory reaction in the surrounding tissues. The proliferating fibers will gradually form a new 'wall' to replace the blood clot, and the leak will be completely blocked. .

This method is very cleverly conceived. Not only is it less invasive, it is convenient and fast, and it can also be used repeatedly if it relapses later.

Zhou Qiao has never failed in surgery since his debut. If other doctors performed this epidural blood patch, there might be a chance of failure, but for Zhou Qiao, the success rate is 100%.

Top famous doctors are so arrogant.

"Of course, there are some precautions after surgery. You need to stay in bed for a period of time. You cannot sit up, let alone get out of bed and walk. At the same time, you should drink plenty of water. It should be almost done after two weeks. At that time, the head CT will be reviewed to evaluate the effect. Before Lei You can continue to take the atorvastatin drug recommended by Dr. Chel."

On the third day after the operation, Mr. Carliss was discharged from the hospital and went home to continue "lying down".

Two weeks after the operation, I came back for a review. Sure enough, the CT film showed that the subdural blood accumulation had been significantly absorbed, and the lateral ventricles were also enlarged compared to before, indicating that the patient's intracranial pressure had tended to be normal and he could try to get out of bed.

"It's really great." The Carlisses were very pleased. Firstly, the recovery is fast, and secondly, there is only one needle hole, and the previous surgery was painless.

The incidence of brain leakage is not high. Some will appear after spinal stretching exercises such as yoga, trauma, and surgery, and some have unknown causes.

Sometimes the symptoms of such patients are not so typical, and may also be accompanied by dizziness, nausea and vomiting, facial numbness, tinnitus, diplopia, etc. In addition, they may also suffer from coma, dementia, combined fever, hyperprolactinemia, intracranial venous thrombosis, etc. possible.

Due to its complex clinical manifestations and diversity of imaging features, it is difficult to diagnose. Even one-third of patients with low intracranial pressure have normal or high pressures measured by lumbar puncture, so they are easily overlooked. Lei Chel is positioned as a grassroots doctor, so it is normal that he cannot make a diagnosis.

Rachel, Vivica, and Jenard are also very aware of their status in the clinic, so they are not depressed.

What's so frustrating about this? If you encounter a problem that you can't solve, just "refer" it to your boss. The job responsibilities are just different.

(End of this chapter)