The Enhanced Doctor-Chapter 542: What is the diagnosis that is eager to express?
Liu Banxia had a pretty good night’s sleep, rising promptly at five in the morning. After washing his face, he headed straight to the upstairs ward.
"Teacher Liu, he’s still sleeping soundly without any abnormal fluctuations on the EEG," Huang Bo reported.
"It really might be schizophrenia. Let’s keep observing. When Miao Rui wakes up, I’ll ask him to take over, so you can get some rest," Liu Banxia suggested.
Huang Bo nodded, not arguing this point.
Sleep was an absolute necessity if one was to function during the day. Everything else could be managed, but not lack of sleep.
Upon arriving at the cafeteria, he saw Xu Yino and the others sleepily eating breakfast.
"How long did you sleep?" Liu Banxia asked.
"Went to bed around twelve, slept plenty. Su Wenhao covered the second half of the night shift in the lobby. He’s catching up on sleep now," Xu Yino answered.
"Teacher Liu, aren’t you and your wife going to get your marriage certificate today? Don’t forget to bring us some wedding candies; it’s a joyous occasion, after all."
Liu Banxia chuckled and nodded. "The candies are already prepared, but it also depends on how that fellow does today. If we can’t diagnose him, I’ll have to go tomorrow."
"Teacher Liu, we should be close to a diagnosis, right? He’s been quiet all night," Miao Rui interjected.
"In terms of monitoring, we should give it at least twenty-four hours. Also, he hasn’t had proper sleep for a long time; we need to keep observing," replied Liu Banxia.
As they were eating, Liu Banxia’s phone rang. Seeing it was a video call request from Huang Bo, he frowned slightly and quickly accepted. When the video connected, the image on screen startled him.
The patient was lunging and jumping around the room, performing various actions, as if fighting someone or avoiding something.
He couldn’t eat another bite and rushed upstairs.
Upon reaching the upstairs ward and just entering the room, he saw the patient swinging a chair around.
"Teacher Liu, the patient suddenly woke up and took off the medical patches. I called his name, but he didn’t respond. This must be sleepwalking, right?" Huang Bo asked nervously, his forehead beaded with sweat.
"That’s probably it. Don’t disturb him for now. How long has this been going on?" Liu Banxia asked.
"Nearly ten minutes. At first, he wasn’t this agitated. Then, for some reason, he started swinging the chair," Huang Bo replied.
"Let’s wait. We’ll see after he calms down. He must be quite exhausted," Liu Banxia suggested.
After waiting for about ten more minutes, the patient flung the chair aside, crawled under the bed, and went quiet.
Only then did Liu Banxia and the interns go closer. The patient was now curled up and asleep.
"No wonder he’s so tired from sleeping. He must be having nightmares. He must have expended a lot of energy in such an unconscious state," Liu Banxia surmised.
"Teacher Liu, so what do we do now? Should we wake him up?" asked Liu Yiqing.
"Yes, wake him up. He might still be in a nightmare. In fact, this is somewhat similar to what we commonly call sleep paralysis. This puts a lot of strain on the mind," Liu Banxia analyzed.
Miao Rui nudged the patient, and gradually, he opened his eyes, looking terrified.
"Did I have a nightmare again? Was I sleepwalking again?" the patient asked, sounding exhausted as he crawled out from under the bed.
Liu Banxia nodded. "Next, we’ll perform a lumbar puncture on you to see if you have encephalitis. This kind of situation can also occur with conditions like encephalitis."
"Can you remember what you dreamt about? You were making quite a commotion in the ward just now. Was it very scary?"
"It was terrifying. I was being chased by a pack of wolves. I ran over mountains and ridges but couldn’t escape. I picked up a stick, but eventually, I ran out of energy, and then I don’t know what happened," the patient recounted.
"Lie back down on the bed. We’ll perform the lumbar puncture, and you can get some rest," Liu Banxia informed him.
"Doctor, can a lumbar puncture help diagnose this?" the patient asked after lying down.
"I can’t give you a definitive answer right now. We need to determine whether this is due to an organic lesion or if it’s purely neurological," Liu Banxia replied, sitting beside the bed.
"Now, I need to ask you about your family history. Within the last three or four generations of your family, has anyone had any form of mental illness?"
"No, I’ve never heard of anyone having it. Doctor, are you suggesting that I have a mental illness?" the patient queried.
"We can’t be sure yet; that’s why we’re doing these tests. Don’t be nervous. Although the situation is a bit complicated, we’ll eventually find some leads," Liu Banxia reassured him, then signaled to Liu Yiqing.
This was probably the last test they could perform. If it still yielded no findings, it would be really difficult to determine the cause.
After all, the cause of schizophrenia is unknown. It has a certain hereditary component and can also occur spontaneously.
"Teacher Liu, his intracranial pressure is slightly high," Liu Yiqing, who was performing the lumbar puncture, said.
"Hmm... This could be related to the nightmare he just had. It wasn’t evident on the head CT scan we did yesterday," Liu Banxia said.
"Doctor, what’s high?" the patient asked.
"It’s the pressure in your brain. For some people, this pressure is persistently high; for others, it’s intermittent. Yours is only slightly elevated right now, so I can’t yet determine if it’s a normal physiological fluctuation or not," Liu Banxia explained.
"So, if it’s not normal, does it mean I have a mental illness?" the patient asked.
"Actually, if it’s not normal, it would indicate another medical condition is causing your intracranial pressure to rise," Liu Banxia responded with a smile.
"Many things can cause it: head injuries, cerebrovascular diseases, intracranial inflammation, liver or kidney failure, blood disorders, poisoning, and so on. Any of these could potentially increase intracranial pressure."
"Don’t worry. I’ll arrange for someone to stay with you. You slept very well last night, which indicates this condition isn’t constantly active."
"It’s just that your episodes are quite intense, which is why they lead to fatigue. Plus, the nightmares are making you very tense. Later, we’ll run some blood work and a urinalysis to check your liver and kidney functions again."
"Okay, okay! If it’s a physical illness, that’s good. An illness can be treated." The young man’s voice carried a hint of relief.
Liu Banxia sighed inwardly. This illness really seemed to be tormenting the young man. He was now inclined to think the young man might have encephalitis.
The brain is still quite mysterious. It might not be severe encephalitis, just enough to stimulate certain nerves and cause this series of symptoms.
After Liu Yiqing completed the lumbar puncture, she quickly sent the sample for testing. Having just witnessed the patient’s episode, this couldn’t be delayed. Not to mention, Liu Banxia had a busy schedule today and couldn’t afford delays either.
"We must consider other potential diagnoses now. Even if the intracranial pressure is only slightly elevated, we cannot ignore it," Liu Banxia said after leaving the room.
"Teacher Liu, could it be an autoimmune disease? Or perhaps caused by toxins?" Xu Yino asked.
"The possibility of toxins is rather low. They are not that widespread in our country. Furthermore, he stayed in the hospital yesterday and was completely separated from his home environment," Liu Banxia explained.
"It’s hard to say about autoimmune diseases. We’ll see what today’s blood and urine test results show. If it is an autoimmune disease, there would usually be some indicators."
"But from his description, apart from the nightmares and sleepwalking, he has no other discomforts. That’s what’s troubling. He even removed the patches himself."
"This also implies that his condition is more severe. Normal sleepwalkers just walk around and occasionally do simple tasks. His level of consciousness must have been quite high, wouldn’t you say?"
The interns all nodded. The force with which he’d swung that chair wasn’t something an ordinary person could match.
There was a chair nearby, which he’d used as a weapon. What if it had been a knife? Swinging that around would have been far more dangerous.
It was still early, so they returned to the cafeteria to finish their breakfast. Wasting food was out of the question, and besides, they’d get hungry later.
"Why was everyone so quiet during the meal? Were you all mulling it over?" Liu Banxia asked as they walked back.
"Teacher Liu, there’s really nothing left to guess at this point. We can only wait for the results, right?" Huang Bo asked.
"Yes, it seems like there’s a genuine illness at play. You should go take a nap now and come back at half-past nine," Liu Banxia nodded.
"Teacher Liu, if the diagnosis is confirmed, please let me know," Huang Bo requested.
"Don’t worry, it’ll be difficult not to inform you," Liu Banxia responded.
Back in the emergency center, Liu Banxia was still pondering the case. There were so many possible causes for increased intracranial pressure. He hoped the lumbar puncture would provide a clear answer.
However, when the results of the lumbar puncture, blood tests, and urinalysis came back, his brow furrowed deeply.
Everything was still normal: no damage to liver or kidney function, and no encephalitis.
"What on earth is going on? Do we have to go back to schizophrenia? Why else would his brain be sending out such chaotic signals?" Su Wenhao, who had just woken up, asked with a grimace.
"Exactly! This illness is so tormenting. Could it be a new disease, like that auto-brewery syndrome, one that just gives you nightmares to terrify you?" Liu Yiqing grumbled.
"Eh? Dr. Liu, that’s quite an insightful comment," Liu Banxia said, his eyes sparkling.
Liu Yiqing was taken aback. At first, she thought Liu Banxia was teasing her. But now, he was rubbing his chin, looking like he was seriously considering it.
"Teacher Liu, what disease are you thinking of?" Liu Yiqing asked.
"Considering the patient’s current symptoms, he’s fine during the day; the symptoms only appear after he falls asleep. And we haven’t found any other physical problems, right?" Liu Banxia asked.
The interns all nodded.
"Then, the answer seems to be right on the tip of my tongue. Think carefully: what kind of illness only affects the brain and has no other systemic effects?" Liu Banxia asked with a broad smile.
The interns were baffled. Tip of his tongue? How could it be? They still hadn’t found anything.
