The case is a foreign patient.
An elderly woman in her 70s, suffering from diabetes, eating metformin, has good blood sugar control. The physical fitness has always been very good, swimming, dancing, housework, quite energetic.
However, last autumn, there was a situation of numbness and weakness in the hands and feet, and I could not swim.
So, I went to the hospital.
Diabetes well, hang up endocrinology.
Diabetics, eating metformin, numbness in hands and feet, it is easy to think of peripheral neuropathy caused by diabetes, especially eating metformin and not taking vitamin B12 that is, methylcobalamin, vitamin 12 is more likely to be lacking, and neuropathy can also be imagined.
Therefore, the endocrinologist checked her B vitamin level, said that it was reduced, and added methylcobalamin.
At the same time, because of acquaintance, the patient called me for consultation and sent me a test form.
From the test list, the level of B vitamins in the patient's blood, although low, is also in the normal range. Of course, this can only be used for reference. Vitamin B12 supplementation when eating metformin is also right (sugar friends pay attention, eat metformin to remember to supplement vitamin B12 Oh!). ）。
However, according to the patient, feeling numbness in the limbs is accompanied by weakness, and the problem of cervical spondylosis should also be considered.
Because there is a cervical spondylosis called "cervical spondylosis of the spinal cord". It is because the spinal cord of the neck is compressed, and the limbs are numb and weak, and there are sensory and motor impairments.
Why do cardiologists know about this disease? Because cervical spondylosis of the spinal cord can also be manifested as symptoms of heart disease, chest tightness, chest tingling sensation, ECG ST segment can also be changed, clinical also need to be distinguished.
Therefore, remind the patient to check the cervical spine, do a magnetic resonance of the cervical spine, and exclude spinal cord-type cervical spondylosis.
The patient returns to the doctor.
When the patient proposed to check the cervical spine, the doctor prescribed a CT of the cervical spine. That's okay, do CT first, and then do MAGNETIC resonance. One of the differences between CT and magnetic resonance is that CT looks at the bone quality well and looks at the vertebrae well; magnetic resonance looks at the soft tissues well, and the spinal cord is good, each has its own strengths.
CT reports of varying degrees of disc lesions in multiple cervical spines.
If it is further successfully investigated, the problem will be solved quickly.
However, something went wrong when I looked at the results of the follow-up examination.
After a CT examination of the cervical spine, you should go to the orthopedic department, and if you are re-divided, you can go to the spine surgery department and see a specialist in the cervical spine. There is a lesion in the cervical spine, to see if the spinal cord is under pressure, you should also do a magnetic resonance.
However, the patient went to the internal medicine department, the neurology department.
The patient also thought about avoiding misdiagnosis, went to different hospitals, hung up 7 or 8 different expert numbers, but all were neurology, so it did not help.
A few months later, the symptoms were worsening, and the patient finally thought of going to the orthopedic department and going to see a specialist in spine surgery.
The results are immediately in sight.
The specialists in spine surgery looked at the cervical SPINE CT film and felt that the lesion was obvious, and further did the cervical magnetic resonance imaging. It shows that there are different degrees of disc herniation in the 3rd to 7th cervical vertebrae, of which the 4th and 5th cervical vertebrae are the most obvious, and the herniated disc compression causes spinal canal stenosis and spinal cord compression. At this point, the diagnosis is clear, myelopathy cervical spondylosis. Surgery is required.
The spinal cord is the nerve center, and this part of the cervical cord can control the whole body. If you are under pressure, you will be paralyzed at a high level, and even your life will be in danger.
Spinal canal stenosis, which means that the space that houses the spinal cord is narrow. In this case, if the cervical spine is subjected to external force, the spinal cord inside is vulnerable to impact and damage. The most typical is that when the brakes are sharp, the person first "throws" forward and then backwards, the cervical cord is "whiplash wound", and the spinal canal is narrowed, which is the most dangerous.
Therefore, spinal cord cervical spondylosis is generally to be operated on, relieving spinal cord compression and relieving spinal stenosis. Surgery is performed not only to address the current spinal cord compression, but also for the safety of the spinal cord in the future.
As a result, the patient had cervical spine surgery and is currently recovering.
【Reminder】
* Many diseases are not so simple, and there will be overlap in clinical manifestations, which is easy to confuse. Just like diabetes, the elderly are more common; cervical spondylosis of the spinal cord, which is also common in the elderly, can be numb in the hands and feet, so it is also necessary to distinguish well when the doctor sees the doctor.
* After taking a picture of the spine and joints, be sure to see the orthopedic department first. Because doctors are sub-specialties, the art has a specialty.
* For neck, shoulder and low back pain, be sure to clarify the diagnosis and then consider whether to treat manually. Because some lesions are not suitable for massage, orthopedic and other manual treatment.
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