Today's case is a male patient, 39 years old, married.
3 years ago, he suddenly appeared unconscious, undesirable, fell to the ground, and then his limbs stiffened and convulsed, the family was very scared, hurriedly carried to the car to the hospital, on the way the patient stopped convulsing and woke up. The family asked him if he remembered what had happened, and he didn't have any memory.
When I went to the hospital, the doctor arranged a CT examination of the skull, and found no abnormalities.
There was no evidence of cerebral hemorrhage, cerebral infarction, brain tumor, etc. that the doctor was worried about, and later several EEG were done, indicating a mild abnormal EEG, and the diagnosis was "epilepsy".
Epilepsy is what rural people call "sheep madness". Patients will suddenly faint, convulsions, limbs rigidity, eyes turned up, mouth foam, looks scary, in fact, is the consequence of abnormal brain nerve discharge, the brain is abnormal, but the existing cranial CT and MRI can not find lesions, some people do EEG can be found, but there are also many epilepsy patients EEG no obvious abnormalities.
This hospitalization diagnosed epilepsy, and when he was discharged from the hospital, he brought some anti-epileptic drugs, mainly sodium valproate. The doctor instructed that long-term eating can avoid recurrence.
But less than 2 months after returning home, the disease recurred, just got up that morning, and then fell out of bed, convulsing desperately, eyes upturned, no foam, lasted for a few minutes before stopping, and then gradually woke up.
The family feels that this is not the way, changed a hospital to see, and did a head CT, MRI, electroencephalogram, the doctor believes that epilepsy is the highest possibility, but do not rule out that there is a heart, some arrhythmias will have convulsive seizures, this is called Ass syndrome. Because the heart may not be able to continue pumping blood when there is a severe arrhythmia, the brain is severely ischemic in a short period of time, resulting in brain dysfunction, so there will be convulsions and unconscious disorders.
It is suspected that it is arrhythmia, but the 24-hour Holter ELECTROCARDI, cardiac color ultrasound, etc. have not found abnormalities, and the 24-hour Holter ECG has been done several times, and no obvious arrhythmias have been found.
Had to prescribe one more anti-epileptic drug, phenobarbital, so that home to strengthen the medicine, maybe can be controlled.
This time it seems to have some effect, and there have been no obvious convulsive episodes for half a year.
Fortunately, I did not expect that one day after half a year, the situation came again.
This time it was not convulsions and impaired consciousness, but sudden loss of emotional control, irritability, gibberish, 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 the home, and the clinic doctor looked at this posture and asked the patient whether he had been bitten by a dog recently, whether it would be rabies.
If it is really rabies, it is certain to die.
But the family has been accompanying the patient himself, never bitten by the dog, there is no dog at home, there is no one in the nearby neighbors to raise a dog, it is impossible to be bitten by the dog, besides, it is impossible for the dog to bite such a big thing, the patient himself can not tell the family.
While he was talking, the patient gradually calmed down again and returned to normal. When asked if there was any dog bite, they said no. I don't remember what just happened. It is that people are very tired, very hungry, and want to eat.
After eating, I gradually regained my spirit and strength.
When such a thing happened, it was terrible, before it was falling to sleep on the ground and convulsing, the eyes turned up to look scary, and now it is shouting, gibberish, terror, and eating the anti-epileptic drugs given by the doctor is not good, this is not epilepsy, the family is worried.
At this time, a neighbor (yes, the neighbor also saw the patient's seizure) offered a plan, saying that so-and-so also had such a seizure, and was later cured by Daxian. If you don't ask the Great Immortal to come and have a look.
As long as you can control the disease and drive away the evil spirits, you all want to try it, which is the expression of the family.
The Great Immortal came and said that there were indeed ghosts and monsters who wanted to cast spells, and it would take 3 consecutive spells in twenty-one days, once a week, to have an effect. That's true.
The day after the spell was cast, the patient began to convulse again. This time it was similar to the previous convulsions, the only difference being that it was accompanied by urinary and urinary incontinence.
Hurry to the hospital, this time the patient in the car has been smoking, to the hospital emergency department, still smoking, intermittent convulsions, people are not awake, emergency department doctors heard that patients have epilepsy, and has been taking medicine, but still poor control, immediately gave a shot of intramuscular injection of stabilization (diazepam injection, a sedative anti-epileptic drug, can quickly terminate the convulsions).
After waiting for a few minutes, the convulsions were still continuing. Preparing to change the second drug to terminate epilepsy, the nurse reported that the doctor, the patient's blood sugar is not good, only 1.9mmol / L.
Every unconscious patient routinely checks the fingertip blood glucose, which is the process. Originally, I was ready to prick my finger to measure blood sugar at the beginning, but the convulsions were more severe, and there was no way to collect blood, so I had to inject a stabilization needle first, and then collect blood.
I didn't expect this one fingertip blood sugar to find such a big problem, low blood sugar. Normal people's fasting blood glucose is 3.9-6.1mmol/L, and random blood glucose (that is, whether it is fasting or not, come to the test, the meaning of testing at any time) will not be lower than fasting blood glucose, but it will not be too high, generally around 4-9mmol/L, and now a 1.9mmol/L is measured, which is definitely a problem.
Such a low blood sugar can completely cause convulsions. The doctor told the family.
But he is obviously epileptic, and the previous use of anti-epileptic drugs also has some effects. The family does not understand.
Either way, make up your blood sugar first. The doctor let Jing push 40 ml of high concentration glucose.
Glucose has just been pushed, immediately, the patient is awake, and there is no convulsion.
Everyone didn't expect this to end.
A needle of glucose went down, and the patient's convulsions were controlled, and the person was also awake, although he was a little tired after waking up, but his spirit was good and he answered freely.
The doctor said that this is definitely not epilepsy, nor is it a convulsion caused by arrhythmia, but may be an endocrine problem, a convulsion caused by hypoglycemia, and even the family members said that shouting at home may be caused by hypoglycemia.
There is a suspicious point, if it is really caused by hypoglycemia, then before giving glucose or eating, the patient should not get better, but in fact, the patient for such a long time every seizure can be relieved by itself. It's just that the time is long and short.
Anyway, I'll go to the endocrinology department first.
The endocrinologist re-evaluated the condition and decided to be highly suspicious of a disease, an insulinoma. There is a piece of tissue in the human pancreas called islets, and the islets can secrete a hormone called insulin. And insulin is the only hormone in the human body that can lower blood sugar, if this tissue grows a tumor, resulting in increased secretion of insulin, then the patient will certainly frequently occur hypoglycemia, most people low blood sugar is panic, hand shaking and other manifestations, very few people may be directly manifested as convulsions, confusion, as if this patient.
The analysis makes sense, and the next step is to look at the results of the examination.
The doctor first checked the blood insulin level of the blood, then sent it to do an abdominal CT, and then did a sugar tolerance test (OGTT), an insulin release test and a series of other tests.
The results came one after another, confirming the doctor's speculations. The patient's blood insulin level is elevated, the insulin release index is also abnormal, and the most critical abdominal CT may show a high-density nodular shadow of the pancreatic head, which is considered to be an islet cell tumor.
Comprehensive evaluation, diagnosis: insulinoma.
This tumor is the hiding place of criminals, and the only way to cure it is to surgically cut off this tumor and reduce insulin cells in order to eliminate excessive insulin secretion.
The patient himself also lamented that his uncle had diabetes, and the doctor said that insulin secretion was insufficient, so the blood sugar was high. I can't imagine that I secrete too much insulin, causing hypoglycemia, and if I can, I'd rather give my insulin to his uncle a little, and it's the best of both worlds.
It's a joke, of course.
The patient was soon placed in surgery to prepare for insulinoma removal.
The procedure was relatively smooth, with a substantial mass the size of a coin in the pancreatic head and neck that the surgeon removed completely. The final pathological result is: insulinoma.
Finally, the truth came out.
The next day after the operation, the patient's fasting blood glucose was measured, which was higher, and the postprandial blood sugar was also higher, but after a few days, the blood glucose and insulin conditions gradually stabilized.
After six months of follow-up, no more seizures of any kind, no convulsions, no falling to the ground, no yelling, no gibberish, everything returned to normal. The family said that this time it really drove the little ghost away.
The doctor talked about another case, there was a convulsive patient, a young man in his 20s, has been hospitalized, but also repeatedly diagnosed epilepsy, every seizure, static push and stabilization needle effect is good, can be eased, but this situation lasted for several years, the drug can not be controlled, must be each seizure when the static push and stabilization needle, and then there is a careful doctor found the problem, this is not right, where there is such a stubborn epilepsy, and finally he detected the abnormality, Every time the nurse pushes the stabilizer needle, it is matched with the glucose injection, perhaps the glucose injection has played a role, not the stabilizer needle has played a role.
When the next seizure came, he immediately pricked the patient's finger on the blood glucose, and looked, Oh my God, it was really low blood sugar. Patients have been suffering from the stabilization needle for so many years, in fact, a glucose can solve the problem. Later, I continued to check, which was also an insulinoma. But unfortunately, due to the long delay, the patient's repeated hypoglycemic convulsions have caused some damage to the brain.
Patients in this article are still lucky.
Insulinoma is a tumor of β cells from the islets, a common islet endocrine tumor, accounting for about 75% of islet cell tumors, mostly benign tumors, but even so, repeated hypoglycemia can cause great problems. The disease can occur at any age, there is no gender difference, the clinical manifestations are diverse, there are four main blocks: sympathetic excitement (such as panic, hand shaking, etc.), impaired consciousness (direct fainting), mental abnormalities (shouting, gibberish), temporal lobe epilepsy (that is, the performance of the patient at the beginning of the text).
Due to the diversity of insulinoma symptoms, it is easy to misdiagnose as psychosis, epilepsy, hysteria, etc., if not diagnosed and treated in time, due to long-term repeated hypoglycemic seizures can lead to irreversible damage to the brain, just like the young man in his 20s in the text.
This article is based on a true case, and the case comes from the reader.