Text/Yangcheng Evening News all-media reporter Zhang Hua correspondent Wei Xing
Photo/Supplied by the hospital
In recent Guangzhou, the cold spring and the continuous spring rain have added a lot of chills. The 25-year-old Ms. Zhang, who just gave birth to her second child, was transferred to the Department of Neurology, Guangzhou First People’s Hospital because of frequent vomiting for two weeks, accompanied by dizziness, and unsteady walking. Unexpectedly, she suffered sudden cardiac arrest and cyanosis. …
The sudden change made the family overwhelmed, and the medical staff in the Neurology Intensive Care Unit (NCU) of Guangzhou First People’s Hospital were well-trained, responded quickly and participated in the rescue, calmly and skillfully on the side. While performing cardiopulmonary resuscitation, she urgently performed bronchofiberscope nasotracheal intubation and established a fluid rehydration channel. After two minutes, Ms. Zhang recovered her heartbeat and breathing, and regained consciousness on the same day. You know, 6 minutes of cerebral ischemia can lead to irreversible brain damage.
Medullary lesion, normal cerebral blood vessels
However, Ms. Zhang’s MRI on admission showed: bulbar lesion . The medulla oblongata is the life command center. Although Ms. Zhang saved her life, she was unable to get off the ventilator due to the medulla oblongata disease, which resulted in quadriplegia and weakness of the respiratory muscles.
What is so dangerous?
Yu Jianmin, Chief Physician of the Department of Neurology, Guangzhou First People’s Hospital, introduced that on the second day when Ms. Zhang was transferred to the NCU, she was diagnosed with neuromyelitis optica spectrum disease-extreme posterior zone syndrome. It turned out that in order to diagnose the condition as soon as possible and give effective treatment, the medical staff quickly developed a number of targeted measures.
First of all, take a detailed medical history for the patient, especially for the source of infection that may come into contact with, or the repeated symptoms ignored by the patient in the past; Routine and other tests, normal thyroid function, but abnormal thyroid immunity, abnormal liver function, normal bilirubin. Antinuclear antibodies (ANAs) 3.766, anti-SSA antibodies (+).
Patient undergoing plasma exchange therapy
Inflammatory? immune? Metabolic? tumorous? Differential diagnosis stuck. Nervous system infections, neuroimmune diseases, and metabolic diseases still cannot be ruled out. NCU doctors with rich clinical experience quickly completed lumbar puncture for the patient. The results of NGS in cerebrospinal fluid were negative, and infectious diseases were basically ruled out in combination with EEG. Serum and cerebrospinal fluid antibodies suggest AQP4(+). In the end, the dawn appeared, and the diagnosis was made on the second day after being transferred to the NCU. It was neuromyelitis optica spectrum disease-extreme posterior zone syndrome.
It is known that neuromyelitis optica spectrum disorders (NMOSD) are a group of autoimmune-mediated inflammatory demyelinating diseases of the central nervous system, mainly involving the optic nerve and spinal cord. In 2020, China released data based on the hospital registration system, and the incidence of NMOSD was about 0.278/(100,000-years), 0.075/(100,000-years) for children, and 0.347/(100,000-years) for adults. NMOSD occurs in all ages, mostly in young adults, and the average age of onset is about 40 years old; women are more frequently affected. Commonly used hormone shock, plasma exchange, human immunoglobulin shock, monoclonal antibody drugs and sequential immunosuppressive therapy.
Encourage patients to actively treat and help patients in respiratory rehabilitation treatment
After the diagnosis, Dr. Yu Jianmin’s team first At one time, targeted treatment was implemented for patients: hormone pulse therapy and plasma exchange. During the treatment, Ms. Zhang felt extremely depressed and even refused to cooperate with the treatment. The NCU medical staff patiently explained the patient’s condition and took careful care. The psychiatrist of the neurology department also immediately intervened to assist Ms. Zhang with the strength to fight against the disease.
Patient recovered and discharged smoothly