The original Wang Yuwei Jindi medical digestive liver disease channel was recorded on the line. One day a month ago, a patient with anorexia came to the digestive department
one month ago, the patient had no obvious inducement, anorexia, abdominal distension after eating, accompanied by nausea and vomiting, vomiting was non spray like, occasional diarrhea, no hematemesis, abdominal pain, acid reflux, fever, self-administered omeprazole treatment, the effect was poor. In recent 4 days, only a small amount of porridge was eaten, and nausea and vomiting occurred half an hour after eating.
the patient went to the outpatient department of Gastroenterology for definite diagnosis and treatment, and was hospitalized. The patient has a clear mind, poor spirit and poor sleep for a long time. He was healthy and had no history of disease, allergy, smoking and drinking. The patient is now divorced and her parents are still alive.
this patient can drink barium meal at one time, but he can’t drink half a bowl of millet porridge in one day. The patient’s life is not satisfactory, and there is no family to accompany him. Is it because of psychological factors that he suffers from anorexia?
the blood routine test, biochemical test, coagulation function test, tumor marker test, nail function test, hormone test and immune test were improved, and no obvious abnormality was found. The patient received pantoprazole, metoclopramide, mosapride and other symptomatic treatment, but the patient still had nausea and vomiting.
at the doctor’s urging, the patient’s family members came late. The family members told me that the patient was mentally abnormal and had a bad relationship with his family. Could you find a psychologist?
please consult with the Department of Neurology for physical examination: clear mind, poor spirit, wide vision of both eyes, weak bilateral pharyngeal reflex, normal muscle strength and muscle tension of limbs, negative pathological signs of both sides, hypoesthesia of both upper and lower limbs.
suggestions: 1. Check brain MR; 2. Improve sleep, zopiclone 7.5mg QN, Flupentixol melitracen 10.5mg, one tablet in the morning and one tablet in the afternoon; 3. Consult the clinical psychology department.
the patient’s further brain MR examination showed that: occipital arachnoid cyst, posterior region syndrome, neuromyelitis optica spectrum disease?
methylprednisolone: 1 g intravenous drip, 1 time / D, for 3 days; 500 mg intravenous drip, 1 time / D, for 3 days; 240 mg intravenous drip, 1 time / D, for 3 days; 120 mg intravenous drip, 1 time / D, for 3 days; prednisone: 60 mg oral, 1 time / D, for 7 days; 50 mg oral, 1 time / D, for 7 days; when the sequence decreases to the medium dose of 30-40 mg / D, the time effect of sequential treatment of immunosuppressant is consistent with it Gradually slow down the reduction rate, such as 5mg every two weeks, to 10-15mg orally, once a day, long-term maintenance.
after treatment, the patient did not have nausea, vomiting, dizziness, blurred vision, numbness and discomfort of the right lower limb when walking, no unclear speech, choking cough, poor physical activity, etc. On the 15th day after admission, the patient’s condition continued to improve and discharged from the hospital. He continued to take prednisone, azathioprine, calcium tablets, proton pump inhibitors and other drugs outside the hospital.
nmosd, or neuromyelitis optica spectrum disease, is a group of central nervous system inflammatory demyelinating disease spectrum mediated by antigen antibody mainly involved in humoral immunity. The first onset of nmosd occurred in all age groups, most of them were young and middle-aged, the median age was 39 years old, the incidence of nmosd was significantly higher in women, and the prevalence rate of nmosd in women and men was as high as 1.
nmosd is often associated with autoimmune diseases such as Sjogren’s syndrome and systemic lupus erythematosus. The recurrence rate of nmosd is high. About 60% patients relapse within one year, and about 90% patients relapse within three years. Most patients have severe visual impairment, limb dysfunction or urinary and fecal disorders.
nmosd has six groups of core clinical symptoms, including optic neuritis, acute myelitis, last medullary syndrome, acute brainstem syndrome, acute diencephalon syndrome and brain syndrome. The last medullary syndrome is one of the most important core symptoms. It can be a single first symptom. It is characterized by intractable hiccup, nausea and vomiting, which can not be explained by other reasons. MRI showed that the lesions were mainly located in the dorsal medulla oblongata, mainly involving the final area, showing a flaky or linear signal, which could be connected with the cervical spinal cord lesions. The treatment recommendation of
nmosd is mainly based on some small sample clinical trials, retrospective studies and expert consensus, as well as the treatment experience of other autoimmune diseases. The treatment of nmosd includes acute phase treatment, sequential treatment, symptomatic treatment and rehabilitation treatment. Treatment measures include glucocorticoids, immunosuppressants, plasma exchange, intravenous injection of large doses of immunoglobulin, etc.
References: neuroimmunology branch of Chinese society of immunology. Chinese guidelines for diagnosis and treatment of neuromyelitis optica spectrum diseases [J]. Chinese Journal of neuroimmunology and neurology, 2016, 23:155-166=“ https://luanban.com/category/focus/ ” target=”_ blank” rel=”noopener”>Focus