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Tang Li Li
Neurology
About me
Deputy Chief Physician, currently pursuing a PhD degree, with 13 years of working experience in a top-tier hospital. Have received advanced training and study at Erlangen University Hospital in Germany and Magdeburg University Hospital. Research focus on neuroinflammation and immune-related diseases.
Proficient in diseases
Headache, dizziness, insomnia, anxiety, epilepsy, cerebral infarction, cerebral hemorrhage, inadequate cerebral blood supply, as well as inflammation and autoimmune diseases of the nervous system such as encephalitis, myasthenia gravis, and Guillain-Barré syndrome.
Voices
How is encephalitis diagnosed?
The diagnosis of encephalitis relies on the following aspects. First, it is based on clinical manifestations. If the patient clearly exhibits symptoms such as headache, fever, nausea, vomiting, and signs of increased intracranial pressure, and physical examination shows positive signs of meningeal irritation, then there is a high suspicion of encephalitis. Second, various auxiliary tests can be conducted. Initially non-invasive tests such as electroencephalograms (EEG) and magnetic resonance imaging (MRI) of the skull can be completed. If the MRI reveals significant abnormalities, such as abnormal signals in the frontal and temporal lobes including the hippocampus, then viral encephalitis should be highly suspected. If the EEG shows moderate abnormalities or increased slow waves, it also indicates damage to the cerebral cortex, serving as an indirect indicator of encephalitis. Third, a lumbar puncture can be performed to ascertain any abnormalities in the cerebrospinal fluid (CSF) routine and biochemical tests. If the cell count is elevated beyond ten times the normal value, an inflammatory infection is considered. There is often a minor to moderate increase in protein. The levels of glucose and chloride may decrease in bacterial and tuberculous encephalitis, while they are generally normal in viral encephalitis.
What are the symptoms of cerebral hemorrhage?
Patients with cerebral hemorrhage typically experience sudden headaches during physical activity or emotional excitation as their initial symptom, which may be accompanied by nausea and vomiting. In severe cases, vomiting can be projectile, consisting of stomach contents. If the patient has stress ulcers leading to bleeding and erosion of the gastric mucosa, they may vomit a coffee-ground-like liquid, which is a mixture of gastric juices and blood. Additionally, patients may also exhibit disturbances in consciousness, such as drowsiness, stupor, or even coma. If the patient is conscious, one may observe hemiplegia or paralysis, sometimes accompanied by speech impairments or psychiatric symptoms. Some patients may also experience epileptic seizures.
Is the blood count high in encephalitis?
Not all cases of encephalitis show an increase in blood counts. Elevated blood counts in encephalitis generally occur in bacterial infections, such as the most common pyogenic meningitis. This can cause a significant increase in blood counts, predominantly with neutrophils. Tuberculous meningitis can also show elevated blood counts, but not as prominently as pyogenic meningitis. In cases of viral infection, such as the common herpes simplex virus infection, patients might experience a decrease in blood counts. This is characterized by a reduction in the total number of white blood cells, a lower proportion of neutrophils, and a possible increase in lymphocyte proportion. If the patient has a concurrent lung infection or other bacterial infections at different sites, there might be an increase in blood counts, which can mask the blood abnormalities originally caused by the viral infection.
Does cerebral hemorrhage have a genetic basis?
Cerebral hemorrhage is not hereditary and is not a genetic disease; it is a type of acute cerebrovascular disease. Its occurrence is related to risk factors of cerebrovascular disease, and some risk factors may be related to genetics. Therefore, having a family history of cerebral hemorrhage is considered one of the factors that can increase the incidence rate of cerebral hemorrhage in patients. For example, if a patient's parents have hypertension, diabetes, or hyperlipidemia, these risk factors can significantly increase the likelihood that the patient will also develop these conditions as they age. Long-term hypertension, diabetes, and hyperlipidemia can lead to arterial wall hardening, sometimes resulting in hyaline degeneration. When blood pressure fluctuates, it can easily form microaneurysms that rupture and bleed, thus causing cerebral hemorrhage. Therefore, although cerebral hemorrhage itself is not hereditary, hereditary-related conditions such as hypertension and diabetes might lead to its occurrence.
How to relieve headache caused by hydrocephalus?
Hydrocephalus causing headaches is generally related to high pressure in the brain. Hydrocephalus leads to an enlargement of the ventricular system, compressing the surrounding brain tissue. Since the volume of the skull is fixed, increased accumulation of fluid can cause a rapid rise in internal pressure, leading to headaches. In severe cases, it may cause nausea, vomiting, and disturbances in consciousness, making the patient drowsy, stuporous, or even comatose. In such cases, the main treatment is to reduce the pressure inside the brain. Dehydrating agents, such as mannitol, can be used; however, mannitol mainly removes water from inside the cells and is more effective for cerebral edema than for hydrocephalus. Furosemide can be used to reduce the secretion of cerebrospinal fluid and may have some effect on hydrocephalus. However, the key treatment is likely to be surgical, such as lateral ventricular drainage, which can fundamentally resolve the problem of fluid accumulation but can also lead to complications like infections.
How is encephalitis caused?
Encephalitis generally falls into two categories: one is infectious inflammation caused by pathogenic infections, and the other is immune inflammation caused by abnormalities in immune mechanisms. Among these, the infectious type is the most common, including viral encephalitis, viral meningitis, tuberculous meningoencephalitis, purulent meningitis, and cryptococcal meningitis, which are associated with infections by viruses, bacteria, Mycobacterium tuberculosis, and Cryptococcus, respectively. Additionally, abnormalities in the immune system often cause autoimmune encephalitis, as well as multiple sclerosis and neuromyelitis optica when involving the brain, and acute disseminated encephalomyelitis, all of which are types of autoimmune encephalitis. The treatment approaches for these two types of encephalitis are different. For pathogen-induced cases, treatment primarily targets the pathogens: antiviral drugs for viral encephalitis, antibiotics for bacterial encephalitis, anti-tubercular therapy involving multiple drugs for Mycobacterium tuberculosis infection, and antifungal drugs, such as amphotericin B, for cryptococcal meningitis. For immune-mediated encephalitis, treatments generally involve immunosuppressants, high-dose corticosteroids, or intravenous immunoglobulins.
How is encephalitis in children diagnosed?
If a child presents with fever, headache, nausea, vomiting, or even convulsions and seizures, it is necessary to be vigilant about the possibility of encephalitis. It is advised to seek medical attention in pediatrics or neurology to conduct a thorough examination. First, an MRI of the brain should be carried out to observe if there are any abnormal signals in the meninges or any damage within the brain substance. Second, cerebrospinal fluid analysis via lumbar puncture is essential for diagnosing encephalitis, as encephalitis patients often show significant abnormalities in cell count and biochemistry of the cerebrospinal fluid, allowing for the identification of different types of infections. Third, an electroencephalogram (EEG) is conducted. While EEG specificity is not high, an affected cerebral cortex in encephalitis patients will show abnormal slow waves. Fourth, routine tests such as a complete blood count should be performed; an elevated blood count can indirectly indicate a potential infection in the patient.
What causes epilepsy in the elderly?
If a patient has no history of epilepsy but begins to experience epileptic seizures in old age, it is generally secondary epilepsy, also known as symptomatic epilepsy. All patients should have a clear cause, but with current diagnostic techniques, it is not always possible to find the cause. If the cause cannot be identified, it is called cryptogenic epilepsy. In such cases, it is generally necessary to improve diagnostic methods, such as cranial magnetic resonance imaging (MRI) and cranial magnetic resonance angiography. The most common causes of epilepsy in the elderly are generally cerebrovascular disease, brain trauma, or encephalitis, and in some cases, brain tumors. Any disease that causes brain cell damage can potentially cause symptomatic epileptic seizures. If all imaging examinations fail to reveal any abnormalities, regular follow-ups are necessary to monitor for early-stage tumors that may not be detectable on imaging tests. Meanwhile, antiepileptic treatment should be administered, and routine blood tests, liver, and kidney functions should be regularly monitored.
What to pay attention to during the recovery period of subarachnoid hemorrhage?
Patients with subarachnoid hemorrhage generally have aneurysms or arteriovenous malformations as the cause. After onset, the main symptom is usually headache, with positive meningeal irritation signs found during examination, but no signs of neurological function deficit. Therefore, during the recovery phase, patients generally do not show positive neurological signs and have good limb mobility. It is only necessary to take precautions against the cause of the disease. For instance, if the patient's cerebral aneurysm has not been surgically treated, there could be a risk of rebleeding. Patients should minimize physical activity, rest in bed as much as possible, and avoid aneurysm rupture. Regular blood pressure control is also essential. If the cause has already been addressed, there are not many precautions needed. Additionally, long-term administration of nimodipine is necessary to prevent delayed cerebral vasospasm, generally recommended for a period of four to six months. (Medication should be used under the guidance of a doctor based on specific conditions.)
Myasthenia gravis should be seen in the Neurology department.
Patients with myasthenia gravis should consult the department of neurology, as myasthenia gravis is an immune-related neuromuscular junction disorder. Patients often exhibit pathological fatigue, skeletal muscle involvement, and unaffected smooth muscles. The most common type is ocular myasthenia, followed by mild and moderate generalized forms. Adult patients often have thymomas or thymic hyperplasia. Upon diagnosis of myasthenia gravis, it is essential to perform a comprehensive thymic CT scan. If thymic abnormalities are present, referral to thoracic surgery for treatment is needed. If there is no thymic disease, high-dose steroid pulse therapy may be considered. Additionally, it is crucial to determine whether the patient has other coexisting immune abnormalities, such as hyperthyroidism or connective tissue disease, and tailor the treatment accordingly.