The Enhanced Doctor

Chapter 1243: Chapter 1243: Progressive Paralysis

(Thanks to Beifang Laoye Lang, Muzi Shuiping, LloveYou Yue, and Laoshu Yumao for the monthly ticket support)

"Teacher Liu, I just did a careful exam. There’s nothing abnormal on the child’s body surface. No rashes, no mosquito or insect bite marks, nothing."

Huang Bo reported as he walked out.

Liu Banxia pinched the bridge of his nose. "Nothing on the spine either? No marks from any knock or bump that’s already faded?"

Huang Bo shook his head.

"Help us go to the cafeteria to get food, and see who’s there from pediatrics, internal medicine, and neurology. Call them over for a consultation." Liu Banxia said.

"Okay, I’ll go right now."

Huang Bo answered and ran straight to the cafeteria.

Li Hao didn’t stay idle either. That much food wasn’t easy to carry, so he ran over with him.

"Please don’t panic yet. I’ve already called doctors from other departments to come and do a joint consultation for your child." Liu Banxia said to the boy’s mother.

"Doctor, is Yangyang’s illness very serious?" the boy’s mother asked nervously.

"From what we can see right now, the symptoms are indeed very severe. The key thing is to find the cause." After thinking for a moment, Liu Banxia said.

"So we will do the relevant tests, but we also need to figure out which plan is the best, so that we can do the fewest possible tests on the child."

"Doctor, don’t worry, as long as you can find out what’s wrong with Yangyang, we’ll pay whatever it costs." the boy’s mother said.

"This isn’t about money. Some tests are invasive, so we have to be cautious. We can’t toss the child back and forth." Liu Banxia said.

"Stay with your child for now and keep an eye on his symptoms. If anything happens, call us. Once we work out a plan, we’ll come explain it to you."

The boy’s mother nodded, understanding this was for her child’s sake.

They’d already called so many people for a consultation; that clearly meant they were taking the child very seriously.

But the more it was like this, the more worried she became, because it also meant the boy’s illness was hard to diagnose and very serious.

After a short wait, everyone rushed back, and Liu Banxia and the others gathered in the small meeting room.

"The child is 7 years old and just came back from Sydney. During his connecting flight in China he said he felt unwell, and after arriving here he developed paralysis in both legs." Liu Banxia said.

"Physical exam shows no rash or signs of trauma on the body surface. Head and cervical spine MRI are negative. Blood test results aren’t out yet. Tactile sensation is still present. Let’s all study this together."

"We don’t have much to go on. Could it be some kind of parasite?" said Peng Bo from neurology.

"It’s difficult to collect a stool sample from the child. I’ve also been considering a lumbar puncture. But that test is quite traumatic. I’m also worried his condition might be a progressive paralysis and could continue to evolve."

"If that’s the case, can we rule out parasites? Even if parasites are causing it, they should have some more or less fixed pattern of presentation, right?"

Peng Bo thought for a moment, then nodded. "That’s a point we can consider. So what are you leaning toward right now?"

"I’m inclined to think it’s still an intracranial infection that led to his current condition, but we need a lumbar puncture." Liu Banxia said.

"For now, I’m approaching it as a progressive paralysis. I’ve treated similar patients before—for example, patients who inhaled nitrous oxide, patients with spinal cord hematomas after traffic accidents causing compression, and even the AIDP patient from a couple of days ago—I’ve taken all of these into account."

"Right, and I also went over in my head that case of organophosphate poisoning from a while back, but I’ve gradually ruled that out as well."

"The child is so young, he can’t possibly be using nitrous oxide frequently on his own. And his body surface findings don’t match. On exam we didn’t find any bruises or scars on him. As for AIDP, let’s put a question mark there for now."

"We asked his mom too. She said he hasn’t had any recent infections or diarrhea. But I don’t think we can rule that out yet; it’s possible she just didn’t notice."

"What I’m considering at this point is some disease affecting the child’s central nervous system and causing neurogenic paralysis. What do you all think?"

"Roughly that’s the direction." said Chen Hongyang.

"I’ve seen a lot of pediatric patients, but this boy’s condition is definitely not a common pediatric disease. One direction we can consider is neurotoxins."

"It’s summer in Sydney, right? Kids would be doing more outdoor activities. Could it be ticks? Did you find anything on exam?"

"Teacher Chen, I did the physical exam. I didn’t find anything. I even ran my hand through his hair. If there were ticks, I would have felt them."

"Then could he have come into contact with industrial waste liquids while playing outside, leading to poisoning?" said Wang Huan.

"That doesn’t quite fit either. If it were industrial waste, contact would definitely cause changes on the skin. And the child wouldn’t only have paralysis in both legs; he’d also have symptoms like nausea and vomiting."

"I was overthinking it because he got sick on the plane. This isn’t a movie—no one’s hijacking the flight and installing nerve gas on board. Let’s stick to discussing things that are actually useful."

He had indeed let his imagination run a bit wild: thinking of neurogenic paralysis and then jumping straight to neurotoxins. It’s not that simple; that sort of thing is not easy to pull off.

"In the process of discussion, we can’t abandon even a single possibility." Liu Banxia said with a smile.

"So what do you seniors think next? Where exactly do we start with the tests? Do we do an EMG first, or go straight to a lumbar puncture, or some other test?"

"Let’s do the electromyography first. If the EMG doesn’t fit with AIDP, then we’ll do a lumbar puncture, how about that?" Chen Hongyang asked.

"I think that works. A lumbar puncture is invasive after all, and right now we still can’t rule out AIDP." Peng Bo said.

"But I still suggest that Banxia go over and palpate the child’s spine. What if this is caused by some old injury? Maybe the turbulence from the long flight or some other change made an old hematoma, which hadn’t been compressing the nerve, enlarge?"

"Peng, you’re giving me way too much credit. Even if my orthopedic skills are pretty decent, I still can’t feel a hematoma inside the spinal canal." Liu Banxia said with a wry smile.

"Then should we add a spinal MRI to check what’s going on in the canal?" Wang Huan asked.

"To be on the safe side, we’d better take a look." Peng Bo said.

"We’ve had similar cases before, old injuries from years ago that left sequelae. Back then the hematoma wasn’t severe and was very small."

"Later the patient fell again, which enlarged the hematoma a bit and caused compression of the spinal cord. But it was discovered too late and led to permanent damage."

"All right, let’s decide on that. EMG, MRI, lumbar puncture. If it really is AIDP, we’ll need to look at the cerebrospinal fluid anyway." Liu Banxia said.

That counted as reaching a consensus; even though it was only a directional judgment, at least they now had an initial plan.

"How’s the child doing?"

After walking out of the conference room, Liu Banxia asked.

"Still okay for now. I’ll go check the blood test results, they should be out soon." Xu Yino said.

Liu Banxia nodded, then walked over to the child’s examination bed.

"Doctor, do you have the results now?" the child’s mother asked.

"Right now we have a preliminary assessment. It’s likely that some disease is affecting the child’s central nervous system." Liu Banxia said.

"At the moment we’re considering two main possibilities: intracranial infection, and Guillain-Barré syndrome. Of course, we also can’t completely rule out lumbar spine injury yet, so we’ll be adding a spinal MRI shortly."

"Our work-up is focused on these three directions. The sequence is: first we’ll do electromyography to see what the nerve conduction pattern looks like."

"Then we’ll do a spinal MRI. If the MRI is still negative, we’ll have no choice but to perform a lumbar puncture to assess the child’s cerebrospinal fluid."

"Doctor, is a lumbar puncture very dangerous?" the child’s mother asked anxiously.

"It’s an invasive test and is essentially a minor procedure, so there is definitely some risk. But it’s a very mature, well-established technique, and I’ll perform it on the child myself when the time comes." Liu Banxia said.

"If we want to diagnose intracranial infection and Guillain-Barré syndrome, only analysis of the cerebrospinal fluid can give us a definitive diagnosis."

The child’s mother nodded.

In fact, from the way Liu Banxia had arranged things, it was clear that the doctors didn’t really want to do the lumbar puncture, which was why they’d put it last.

"Teacher Liu, the blood tests are back, all negative." At that moment, Xu Yino came running back.

Liu Banxia nodded. "Take the child for EMG, then the spinal MRI. Let me know when you’re done."

"Okay."

Xu Yino answered.

"Little one, we need you to get up and sit in the wheelchair to go for your tests." Liu Banxia said to the young patient.

The little guy was clearly a bit resistant to more tests, squirming on the exam bed and not wanting to get up.

"Mom, my arms feel weak."

The young patient suddenly said.

Liu Banxia’s heart sank, and he quickly moved to the side of the bed to examine the child’s arms.

"Doctor, what’s wrong?" the child’s mother asked.

"The disease has progressed. It’s indeed progressive paralysis, and now it’s spread to the upper limbs." Liu Banxia said in a low voice.

"Given the situation, to protect the child’s airway, we have no choice but to intubate. The disease is advancing too fast; I don’t know when the respiratory muscles will become paralyzed as well."

Hearing this, the child’s mother was truly terrified. Even if she didn’t fully understand what "respiratory muscle paralysis" meant, she knew that if that really happened, her son would be in grave danger.

"Doctor, do it." the child’s mother said.

"Xu Yino, prepare a pediatric intubation set, 10 units of etomidate, 50 units of succinylcholine. I’ll do the intubation." Liu Banxia said.

He was extremely tense inside, because he had no way of predicting what the condition would look like if it continued to progress.

Even though events were matching his earlier assessment, the speed of the child’s deterioration was genuinely frightening.

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