Jimu news reporter Yan Wen
Correspondent Hu Hong Zhou Lingling
A few days ago, Grandpa Wang, who was octogenarian, went to the ophthalmology department of Wuhan University People's Hospital (Hubei Provincial People's Hospital) because his eyelids were drooping and covering his eyes. Fortunately, the doctor's fire-eyed golden eye saw through the disguise of the disease, pulled out the "real culprit" brain aneurysm, and cooperated closely with the neurosurgery department to carry out MDT cooperation and timely interventional surgery to eliminate the hidden danger of this imminent detonation of the intracranial "bomb".
In ophthalmology, the nerves of the eye (retina and optic nerve) are extensions of the central nervous system, the lesion of which may be a manifestation of a systemic multisystem disease in the eye. As a result, neuro-ophthalmologists can often grasp the clues to distinguish the diagnosis in the process of seeing a doctor, and they are also called "eye detectives" who look at the whole body from the eye. Below, we will take a look at the whole process of solving this classic "eye detective".
"Eye Detective" looks at it more, and the second becomes "Master of Mine Clearance"
On April 2, the 82-year-old Wang Daddy's left eyelid drooped without warning, covering the entire left eye, and he couldn't lift it. What is even more strange is that even if the eyelids are broken open with your hands, the things are blurred and ghosted, so after the state of "turning a blind eye" lasted for a week without improvement, his family rushed him to the ophthalmology department of Wuhan University People's Hospital for treatment.
Professor Shen Yin, who received the treatment, found that the patient's left eye could not open on its own, and only one slit could be opened to the greatest extent, and the eyeball could only turn outward, not inward, nor upward. Further inquiries learned that Daddy Wang did not have chronic diseases such as diabetes and hypertension, and Professor Shen Yin judged with his rich experience that Daddy was suffering from oculomotor nerve paralysis, which may be related to intracranial lesions.
"One more look, and you'll be one step closer to the truth!" Shen Yin took Daddy Wang to the dark room for pupillary reflection examination, and the pupil of his left eye was dilated and did not respond to light, probably because of the oculomotor nerve paralysis caused by cerebral aneurysms, which must be transferred to neurosurgery for treatment as soon as possible.
Why look for neurosurgery for eye problems? Brain CT has just been done, there is no tumor ah? Father Wang and his family were half-convinced. Shen Yin patiently explained that the brain aneurysm is not a solid tumor, it is a tumor-like bulge formed by the long-term impact of blood flow on the blood vessel wall, just like a "bomb" buried in the body, which endangers the patient's life at any time. You must not leave the hospital until the risk of detonation has been ruled out. While persuading her father to undergo brain MRI and CTA examinations, Shen Yin contacted emergency, radiological, and neurosurgery departments to activate the green channel, and strived to clarify the cause in the shortest possible time.
really! It's an aneurysm! Cerebral angiography confirmed Shen Yin's judgment, and two aneurysms were found in the posterior posterior cervical artery on the left side of Daddy Wang's neck. The larger aneurysm is about 8.1 * 6 mm, and its posterior edge is a 5.5 * 4.2 mm nodular protrusion, like a "mother tumor" dragging a small "sub-tumor", which may rupture and bleed at any time, endangering life, and must be swept away immediately.
"Minesweeper Expert" uses several spring rings to exclude "mother-daughter mine"
Daddy Wang was urgently transferred to the Neurosurgery Department, and the MDT team of the hospital's neuro-ophthalmology department consulted overnight. Considering that Daddy Wang's onset time is only one week, Professor Li Mingchang, deputy director of the Department of Neurology I, proposed that early surgical treatment can not only relieve the compression of the aneurysm tumor body on the oculomotor nerve, but also hope to restore its oculomotor nerve function, improve its paralysis symptoms, and more importantly, relieve the risk of rupture of the aneurysm.
If neuro-ophthalmologists are "masters of mine clearance," then the neurosurgical interventional team is the "minesweeper experts": they have to protect complex and weak brain tissue and clear these two "mines" that can explode at any time. The difference between the millimeters during the surgical operation may cause irreparable damage to the patient's nerve central system, coupled with the patient's advanced age, the blood vessels inside and outside the skull are tortuous and stenosis, and there may be spasm contractions of cerebral blood vessels due to the movement of the guide wire during the operation. At the same time, the morphology of the aneurysm is extremely irregular, the parietal tumor wall is extremely thin, it is easy to rupture and bleed, and the difficulty of surgery is multiplied.
On the morning of the 10th, Professor Li Mingchang's team performed cerebral angiography + intracranial aneurysm interventional embolization for Daddy Wang. "Although it is a minimally invasive operation, the operation is not small." Li Mingchang introduced that minimally invasive surgery also requires very high technical and experience of neurosurgery and anesthesiologists.
During the operation, under the guidance of the DSA, Li Mingchang inserted three microcatheters from Daddy Wang's thigh femoral artery, and the thin microcatheter "danced" in the delicate twists of the blood vessels, reaching the tumor cavity of the intracranial artery and the mother-daughter aneurysm. Subsequently, a microcatheter is used to smoothly push and release, and a stent is implanted in the stenosis occlusion section of the blood vessel to maintain smooth blood circulation in the intraoperative luminal cavity. Finally, the two microcatheters extending to the end of the aneurysm are used as channels, and the spring coils are densely filled, thereby blocking blood flow and reducing the risk of rupture of the aneurysm.
After more than two hours of intense and orderly interventional operations, the operation ended smoothly, the postoperative aneurysm was not developed, and the left posterior communication artery was restored. On the first day after the operation, Grandpa Wang's left eye was able to open his eyes.
Practice the fire-eyed golden eye that looks at the whole body from the eye
After the operation, the family of Wang Daddy thanked Professor Shen Yin, the "life-saving benefactor", expressed admiration for her ability to know and see and remove "thunder" at a glance, and expressed gratitude to the MDT team of neurophthalmology for their cooperation in the green channel to serve patients.
It is a bit of an exaggeration to say that the "thunder" is discharged at a glance, but the "people's strength" of neuro-ophthalmology is beyond doubt. Shen Yin introduced that because the brain aneurysm is relatively hidden, there are generally no obvious symptoms when it is not ruptured, and ordinary CT examination is not easy to find, so it is easy to be missed or misdiagnosed. Many patients are diagnosed with cerebral aneurysms after sudden intracranial hemorrhage, and some patients like Wang Daddy mistakenly think that it is an eye problem to go to the ophthalmology department, but they do not know that it is the oculomotor nerve paralysis caused by the compression of the brain aneurysm, which is a typical neuro-ophthalmic disease.
Shen Yin stressed that doctors often find some patients with cranial trauma, head tumors, and cerebrovascular diseases who have symptoms such as visual hemianopia, diplopia, vision loss, and optic nerve atrophy. In traditional medicine, no specialty can cope with such a group of patients alone, but neuro-ophthalmology offers hope for this type of patient.
Unlike traditional ophthalmology, neuro-ophthalmology is an emerging interdisciplinary discipline that is primarily responsible for the study of the ocular-related input and output nervous system. In 2018, the People's Hospital of Wuhan University combined "brain" and "eye", actively explored the road of multidisciplinary integration and innovation, and took the lead in establishing a neuro-ophthalmology MDT group composed of ophthalmology, emergency department, neurology, neurosurgery, vascular surgery, interventional medicine, anesthesiology, radiology, pathology and other disciplines in the province. After nearly five years of exploration and integration, the team summarized and refined the "people's experience" of neuro-ophthalmology in the rapid diagnosis and precise treatment of aneurysms, myasthenia gravis, multiple sclerosis, optic nerve myelitis and other diseases, effectively improving the treatment rate of ophthalmology-related neurosurgery and reducing the rate of misdiagnosis and missed diagnosis.
Shen Yin reminded that aneurysms need to be correctly diagnosed, found and treated in time, and try to intervene before rupture. People with underlying diseases such as pre-existing hypertension, or people with a family history of cerebrovascular disease, can be screened with brain CTA (CT angiography) or MRA (magnetic resonance angiography) on the basis of routine physical examination.