Today’s case is a male patient, 39 years old, married.
Three years ago, he suddenly became unconscious and reluctant for no obvious reason. He fell to the ground, and then his limbs stiffened and twitched. The family was very frightened. The patient stopped convulsing and regained consciousness. His family asked him if he remembered what happened, but he had no memory at all.
went to the hospital, the doctor arranged a CT scan of the head, and the result did not find any abnormality.
There is no evidence of cerebral hemorrhage, cerebral infarction, brain tumor, etc. that the doctor is worried about. Later, several EEGs were performed, which showed mildly abnormal EEG, and the diagnosis was “epilepsy” .
Epilepticus is what the rural people call “epilepsy.” The patient will suddenly faint, convulse, stiff limbs, turn up the eyes, and foam at the mouth. It looks scary, but it is actually the result of the abnormal discharge of the brain nerves. The brain is abnormal, but the existing cranial CT and MRI are all The lesions cannot be found, and some people can find them by doing EEG, but there are also many patients with epilepsy who have no obvious abnormality in the EEG.
This hospitalization was diagnosed with epilepsy. When I was discharged from the hospital, I brought some antiepileptic drugs, mainly sodium valproate. The doctor told me to eat it for a long time to avoid recurrence.
But less than 2 months after returning home, the disease relapsed, just got up that morning, then fell out of bed, convulsed desperately, rolled eyes, no foaming at the mouth, continued It stopped after a few minutes, and then gradually woke up.
The family felt that this was not the way to go, so they went to another hospital to see them again, and also had a CT, MRI, and EEG of the head. For this reason, some arrhythmias have convulsions, which is called Aspen syndrome. Because of severe arrhythmia, the heart may not be able to continue pumping blood, and the brain is severely ischemic in a short period of time, causing brain dysfunction, so there will be convulsions and disturbance of consciousness.
Arrhythmia was suspected, but no abnormality was found in 24-hour dynamic electrocardiogram and echocardiography, and 24-hour dynamic electrocardiogram was performed several times, but no obvious arrhythmia was found.
I had to prescribe an additional anti-epileptic drug, phenobarbital, and let me strengthen my medication when I go home, and maybe I can control it.
This time it seems to have some effect, and there has been no obvious convulsions for half a year.
I am fortunate, but one day after half a year, the situation will come again.
This time, it wasn’t convulsions and disturbances of consciousness, but a sudden loss of control, irritability, hyperactivity, nonsense, and yelling like crazy.
I wanted to take him to the hospital, but the patient himself refused to cooperate, so he had to invite the clinic doctor to his home. The clinic doctor saw the situation and asked the patient if he had been bitten by a dog recently. , Could it be rabies?
If it was rabies, it would be fatal.
However, the family members have been accompanying the patient himself. He has never been bitten by a dog, nor has a dog at home, and no one in the nearby neighbors has a dog. It is impossible for the patient to be bitten by a dog. With such a big thing, it is impossible for the patient himself not to tell his family.
While speaking, the patient gradually calmed down and returned to normal. When asked if he was bitten by a dog, he said no. I don’t even remember what just happened. It just feels like people are tired, hungry, and want to eat.
After eating, I gradually regained my energy and strength.
It’s incredible that something like this happened. Before, I fell asleep and twitched, my eyes rolled up and looked scary. Now I’m yelling, talking nonsense, and terrifying. Moreover, the anti-epileptic drugs given by the doctor did not work well. Is this epilepsy? The family is worried.
At this time, a neighbor (yes, the neighbor also saw the patient’s attack) offered advice, saying that so-and-so also had such an attack, and was later cured by Daxian. Why don’t you invite Daxian to come and take a look.
As long as I can control the disease and drive away the evil, I want to try it. This is the statement of my family.
The Great Immortal is here, saying that there are indeed ghosts and ghosts, and they need to cast spells, and they need to cast spells 3 times in a row within 21 days, once a week, to be effective. Strictly speaking.
A day after the spell was cast, the patient began to twitch again. This time is similar to the previous convulsions, the only difference is that it is accompanied by incontinence.
Hurry up to the hospital, this time the patient kept pumping in the car, and arrived at the emergency department of the hospital, still pumping, intermittent pumpingConvulsions, the person is not awake, the emergency doctor heard that the patient has epilepsy, and he has been taking medicine, but it is still not well controlled, and immediately gives an intramuscular injection of diazepam (diazepam injection, a sedative antiepileptic drug, can quickly stop convulsions).
Waited a few minutes, the twitching continued. I was about to change the second drug to stop epilepsy. The nurse reported that, doctor, the patient’s blood sugar was not good, only 1.9mmol/L.
Every unconscious patient will routinely check fingertip blood sugar, which is the procedure. Originally, I was going to prick the patient’s finger to measure blood sugar, but the convulsions were severe, so I couldn’t collect blood, so I had to inject a diazepam first, and then collect blood.
I didn’t expect this fingertip blood sugar to find such a big problem, hypoglycemia. The fasting blood sugar of a normal person is 3.9-6.1mmol/L, and the random blood sugar (that is, whether it is fasting or not, you can measure it when you arrive, and measure it at any time) will not be lower than the fasting blood sugar, but it will not be too high, generally in 4- It is about 9mmol/L, and now a 1.9mmol/L is measured, which is definitely a problem.
Such a low blood sugar can cause convulsions. The doctor told the family.
But he obviously has epilepsy, and the anti-epileptic drugs have had some effect before. The family does not understand.
In any case, make up your blood sugar first. The doctor let 40ml of high-concentration glucose be injected intravenously.
Glucose has just been pushed, and the effect is immediate. The patient is awake and no more convulsions.
No one expected this to end.
During a single injection of glucose, the patient’s convulsions were actually controlled, and the person was also awake. After waking up, although he was a little tired, he was in good spirits and answered freely.
The doctor said that this is definitely not epilepsy, nor convulsions caused by arrhythmia, but may be endocrine problems, convulsions caused by hypoglycemia, and even the family members said that they were yelling at home. It may be caused by hypoglycemia.
There is a doubt that if it is really caused by hypoglycemia, the patient should not get better until glucose or food is not given, but in fact, the patient has every attack for so long. All can be relieved on their own. It’s just that the time is long and short.
In any case, I will introduce it to the endocrinology department first.
The endocrinologist reassessed the condition and considered a disease to be highly suspected, insulinoma. There is a piece of tissue in the human pancreas called islets that secrete a hormone called insulin. Insulin is the only hormone in the human body that can lower blood sugar. If this tissue grows a tumor, which leads to an increase in insulin secretion, the patient will definitely have frequent hypoglycemia. Most people have hypoglycemia with symptoms such as palpitation and tremors. A few may present with convulsions and confusion directly, just like this patient.
Analysis makes sense, next check the results.
The doctor first took blood to check the blood insulin level, and then sent it for abdominal CT, and further performed a series of examinations such as glucose tolerance test (OGTT), insulin release test and so on.
The results came out one after another, confirming the doctor’s guess. The patient’s blood insulin level is elevated, the insulin release index is also abnormal, and the most critical abdominal CT can see high-density nodules in the head of the pancreas, which is considered to be islet cell tumor.
Comprehensive evaluation, diagnosis: insulinoma.
This tumor is a hiding place for criminals. To cure it, the only way is to surgically remove the tumor and reduce insulin cells, so as to prevent excessive insulin secretion.
The patient himself also felt that his uncle had diabetes, and the doctor said that the insulin secretion was insufficient, so the blood sugar was high. Unexpectedly, he secretes too much insulin, causing hypoglycemia. If possible, he would rather give his uncle a little of his insulin, then the best of both worlds.
This is, of course, a joke.
The patient was quickly referred to surgery for insulinoma removal.
The operation went smoothly. During the operation, a solid lump the size of a coin could be felt in the head and neck of the pancreas, and the surgeon completely removed the lump. The final pathological result is: insulinoma.
The truth is finally revealed.
The patient’s fasting blood glucose was measured on the second day after the operation, which was a little higher, and the postprandial blood glucose was also a little higher, but after a few days, the blood glucose and insulin conditions gradually stabilized.
Follow-up for half a year, no seizures of any kind, no convulsions, no falling to the ground, no yelling, no nonsense, everything is back to normal. The family said that this time the kid was really driven away.
The doctor mentioned another case. There was a convulsive patient, a young man in his 20s, who had been hospitalized and was repeatedly diagnosed with epilepsy. The effect is good, and it can be relieved, but this situation has lasted for several years, and the medicine can’t control it. It is necessary to push the tranquilizer needle every time the attack occurs. Later, a careful doctor found the problem, this is not right, How could there be such a stubborn epilepsy? Finally, he noticed the abnormality. Every time the nurse pushed the stabilizer needle, heIt is matched with glucose injection, maybe it is the glucose injection that plays a role, not the stabilizer needle.
Waiting for the next attack, he immediately pricked the patient’s finger for blood sugar, and when he saw it, God, it was really low blood sugar. The patient has endured so many years of tranquilizer needles in vain, but a single dose of glucose can actually solve the problem. Continue to check later, is also insulinoma. But unfortunately, due to the long delay, the patient has repeated hypoglycemic convulsions, which has already caused certain damage to the brain.
The patient in this article was lucky.
Insulinoma is a tumor derived from islet beta cells. It is a common islet endocrine tumor, accounting for about 75% of islet cell tumors. Most of them are benign tumors, but even so, repeated hypoglycemia can cause big problems. The disease can occur at any age, with no gender difference, and the clinical manifestations are diverse. There are four main blocks: sympathetic nervous excitement (such as palpitation, tremors, etc.), disturbance of consciousness (passing out directly), mental abnormality (yelling and yelling) , nonsense), temporal lobe epilepsy (that is, the performance of the patient at the beginning of the article).
Because of the diverse symptoms of insulinoma, it is easy to be misdiagnosed as mental illness, epilepsy, hysteria, etc. If not diagnosed and treated in time, the long-term repeated hypoglycemia can lead to irreversible damage to the brain. Like the guy in his 20s.
This article is adapted from a real case, and the case comes from the reader.