Today, dopamine saw a video on the Internet.
There is a 14-year-old girl in the video, but she has been suffering from diseases for many years.
This disease is very strange, once the onset of the disease, the little girl will fall into a "deep sleep", the time varies from a few days to half a year.
This father is alone to take care of patients, life is not easy, he affectionately called his child "Sleeping Beauty".
Life has given us a lot of suffering, but we should not let a flower girl suffer like this.
The current situation of this child, and everyone's doubts about the video, have aroused dopamine's thinking: what is wrong with her?
Let's get to the point:
There is an important system in the human brain called the "brainstem uplink mesh activation system", what is its use?
It receives collateral feeders of various sensory information, sends excitatory signals from the brainstem to the non-specific nuclei of the thalamus, and then diffuses and projects them to the cerebral cortex, keeping the entire cerebral cortex excited, so that we maintain an awake state.
In other words, the reason why we have normal consciousness depends on the normal work of this system.
In other words, if a person's ascending reticular activation system or bilateral cerebral cortex is damaged, the person develops a disturbance of consciousness.
Everyone has studied Neurology and has a certain degree of understanding of disorders of consciousness.
So, before we understand the condition of this little girl, we must first understand what is called "consciousness"?
Consciousness is the human body's ability to perceive its surroundings and its own state.
In the most popular words, consciousness is that individuals can feel various stimuli such as the cold, heat, pain, and noise of the surrounding environment, and can also perceive the state and changes in their own body.
Someone pinches you, you can know the pain, you know that it is the harm that others have brought to themselves.
You lie there with your eyes closed, you can hear someone calling out to you, you can smell the flowers, you can know where you are lying, where you are.
This is consciousness, or many of the paraamines are not expressed rigorously, but this is what we ordinary people call "consciousness."
From a medical point of view, consciousness can be divided into a disorder of consciousness with a decrease in the degree of arousal as the main manifestation, and a disorder of consciousness with a change in the content of consciousness as the main symptom.
What's the difference between the two?
As the name suggests, the impairment of consciousness with decreased arousal as the main content is that the patient may not wake up or need a larger stimulus intensity to wake up.
For example, drowsiness, the patient can still be woken up, if you do not call him to stimulate him, he will always sleep there, but if you stimulate him, he will immediately open his eyes.
Slightly more serious is lethargy, this situation is more serious than drowsiness, the patient has been in a deep sleep, normal stimulation has not woken up, must shout at him loudly, afraid to hit him, pinch him, screw him, but he opened his eyes and may just see that you do not speak, or may just say a vague sentence or two.
The most serious is the coma, at this time the patient has completely lost consciousness, no matter how you stimulate, the patient will not open his eyes on his own.
In medicine, we will divide the coma into shallow coma, medium coma, and deep coma.
There is a difference between these three.
Although the patients in shallow coma are completely unconscious, they will still have some unconscious spontaneous movements, do not respond to the general degree of stimulation signals, and will make some reactions to strong stimulation signals, but they will certainly not open their eyes on their own, let alone wake up. It should be noted that the physiological reflexes of patients with shallow coma will still exist, including swallowing reflex, cough reflex, pupil to light reflex, etc.
As for the middle coma and deep coma, the patient's condition is naturally more serious, not only complete loss of consciousness, but also the instability of vital signs, and even the fear of life.
Now let's talk about the second kind of consciousness disorder, that is, the consciousness disorder that changes the content of consciousness, which mainly includes confusion and delirium.
Confusion is when the patient appears indifferent, ignores anyone about anything, does not respond, has decreased concentration, is emotionally indifferent, has disorientation, and lacks language coherence. However, the patient must be awake.
Delirium is actually an acute disorder of higher brain function. In the most popular and vivid words, patients with delirium may have language dysfunction, illusions, hallucinations, which can be manifested as nervousness, excitement, fear, and even swearing and beating people. However, the patient must be awake.
In addition to the above two types of consciousness disorders, we will also encounter some special types of consciousness disorders in the clinic, but they are relatively rare, mainly including ambulatory mutism, decocortic syndrome and vegetative status.
What is ambulatory mutism?
Simply put, the patient looks awake, can open his eyes on his own, but cannot move, as if he has been lit by acupuncture points, and cannot control defecation on his own.
What is Decocortic Syndrome?
Simply put, the patient looks awake but does not respond to external stimuli. Importantly, the patient can unconsciously open his eyes, even be able to rotate his eyes, and the swallowing reflex and corneal reflex will be present. However, the patient's limb tone may be elevated.
As for what is called the vegetative state, everyone should have some understanding, that is, the patient's cognitive function of himself and the outside world is completely lost, he cannot wake up at all, and he cannot establish any communication with the outside world, and can have sucking, chewing, swallowing reflexes, and can also have an awakening sleep cycle, incontinence. This is usually due to severe damage to the cerebral hemisphere, but the brainstem function is partially preserved.
The above types of disorders of consciousness are the most common types in clinical work.
So, let's take a look at the little girl in the video.
From the information provided by the father of the little girl in the video, we can know that the 14-year-old girl was born with cerebral palsy, and was not found until she was more than two years old, and began to have "epilepsy" at the age of 10. "Epilepsy" attack, the little girl began to "sleep", the time ranged from a few days to half a year. Even in a deep sleep, when the little girl is fed, she will sometimes gently open her mouth and swallow slowly.
What information can we get from the short video message?
First, the little girl seems to be in a fairly nutritious state, not comparable to those who are malnourished because of long-term mental disorders. Moreover, the little girl did not use nasal feeding. This shows that even the little girl in the "sleeping" has eaten a lot of food through stuttering.
Second, the patient's father said that the little girl would "fall asleep" after the "epileptic" seizure, and the time ranged from a few days to half a year. Note that epilepsy generally only lasts for seconds, minutes, and hours, even if it is a large seizure, status epilepticus will not last so long; even if the patient with a large seizure is in a comatose state after the seizure, it will not be so long.
Third, from the description of the family, the little girl in the "sleeping" is not only a swallowing reflex, but can eat, because she will gently open her mouth. Know that there is a difference between opening your mouth and swallowing reflexes.
Fourth, from the video, when her father holds her, she will cross her hands and place her legs normally when washing her hair, which shows that the little girl has normal muscle strength and muscle tone is not high.
Okay, now let's use the information we get from the video to compare the various types of disorders of consciousness mentioned earlier.
The first thing that was excluded was drowsiness, because once the little girl "fell asleep", she could not wake up, even for half a year.
The second is lethargy, because according to common sense, once the patient appears to be "shouting and not waking up", the family will definitely try their best to stimulate her, including the common pinch people. I believe this dad also gave the child a strong enough stimulus signal.
So, will it be a coma?
Medium coma and deep coma are certainly not, because such patients are certainly impossible to survive for months or even half a year without medical treatment, at least it is impossible to appear nutritionally normal, and there is a certain amount of muscle strength.
Some people may say that it is a shallow coma, or that sentence, reminding everyone that patients with shallow coma may have swallowing reflexes, but they must not eat normally.
That is to say, patients with shallow coma will have the action of swallowing saliva, but they cannot open their mouths to eat. In general, such patients need to solve the problem of eating through nasal feeding.
Confusion and delirium should be ruled out, because the little girl cannot open her eyes at all when she is ill, it is not emotional indifference at all, and it is not an illusion, hallucination, or attack on others.
As for whether it is apathetic mutism, decocortical syndrome and vegetative state?
In the shallow view of dopamine individuals, it is not.
Of course, there is another situation that needs to be identified, that is, "wooden zombie".
The so-called wooden stiffness refers to not speaking, not eating or drinking, lack of response to stimuli, like a piece of wood, some people even have urinary incontinence, but if you talk to him, when he talks to him, he will even have tears, rapid heartbeat and other phenomena. But again, it is almost impossible for a patient to have a seizure that lasts up to six months.
Since the above common obstacles of consciousness can be eliminated, what happened to this "sleeping beauty"?
From the December 16 discharge record in the dad's video, it can be seen that the child's diagnosis is: 1, epilepsy 2, brain dysfunction, 3, cerebral palsy, 4, mental retardation.
That is to say, at least until the doctor issues this discharge record, the child is not conscious.
And judging from the records in the discharge records:
First, the mental examination is not cooperative, the call is unresponsive, can not be answered, limb pain, temperature, touch and deep sensory symmetry lead out, Babinsky sign negative, Gram sign negative, Brinell sign negative, cerebellar ataxia negative.
Second, the child has epilepsy for many years, but has not taken the medicine regularly.
Third, considering the patient's state of consciousness, it is recommended to indwell the urinary catheter, and the family member requests to be discharged after extubation.
What does the above simple message say?
First, it shows that the patient's condition is not life-threatening for the time being.
Second, the child has epilepsy, but has not received formal treatment for many years.
Third, the child's "sleeping" condition cannot solve the problem of urinating normally.
Finally, what dopamine wants to say is that children are unfortunate, modern medicine has certain limitations, and some problems are really difficult for us to explain. Dopamine never speculates on others with malice, and fully believes in the suffering of children, but does not believe that children will really "sleep" for so long every seizure, maybe the child just can't express it, just emotional indifference, but the family can't express it clearly.
I hope that "Sleeping Beauty" can wake up soon.
Let more people know a little more!