CHAPTER 345: 345 STUNNING STROKE OF GENIUS

(Thanks to friends U18 and Food Safety World for their monthly pass encouragement)

The boy didn’t sleep long this time; he woke up even before the blood test results came out.

Perhaps it was because he had been through this so many times. As a result, he wasn’t surprised by the situation and just rubbed his face a bit, fully waking himself up.

"Brother Hui, we need to figure this out. This kid has narcolepsy and peculiar high blood pressure. None of the different antihypertensive medications we tried have worked," Liu Banxia said as he walked into Xu Hui’s office to discuss the case.

"This is quite problematic. Some patients are resistant to certain drugs, but it’s strange when none at all seem to work," Xu Hui replied.

"He’s only 16. He’s a bit chubby, but not excessively overweight. His blood pressure is at 190, which is quite unusual," said Liu Banxia.

"Could it be due to narcolepsy?" Xu Hui asked.

"It seems likely. The child’s father mentioned that the narcolepsy appeared first, followed by the high blood pressure. We were just discussing his condition with him when he fell asleep mid-conversation," Liu Banxia relayed.

"I’ve reviewed the CT scans from the other hospitals, and there were no noticeable problems with his brain. Moreover, the child hasn’t reported any discomfort, only sleepiness."

Xu Hui grimaced. "I’m stumped. Narcolepsy is frustrating like that. If nothing else works, you might need to consult others. You’ve had it rough, just returning to work and already dealing with two challenging patients."

"Sigh... I just wanted to have an easy day," Liu Banxia responded with a wry smile.

With most illnesses, he could try to do something. But with this patient, the high blood pressure and narcolepsy weren’t easy to manage.

"Dr. Liu, the blood test results are in. They show mild impairment of kidney function," Liang Xiaolin announced, walking in while Liu Banxia and Xu Hui were discussing the case.

"With such high blood pressure, some collateral damage is inevitable," Liu Banxia said, taking the medical report.

He had been worried from the start that the high blood pressure could significantly impact the child’s health, and the test now validated his concerns. However, the results were somewhat reassuring; although the indicators were high, the damage wasn’t severe.

If they could control the blood pressure, the kidneys should theoretically repair themselves. For this patient, however, the high blood pressure was certainly peculiar.

"Dr. Liu, what do we do next?" Liang Xiaolin asked.

"Sigh... there’s no easy solution. Apart from trying different antihypertensive drugs, there isn’t much else we can do. I’m hesitant to order more diagnostic tests since the results would likely be the same as before," Liu Banxia answered.

Initially, I thought the problem might be a small lesion that didn’t show up on the scans. But he’s had so many; if there were a lesion, it likely would have worsened and become apparent by now.

"So, what do we do? Just give up?" Liang Xiaolin frowned.

"I’ll think about it more carefully. If we can’t treat the narcolepsy, let’s see if we can find a new approach for the high blood pressure," Liu Banxia proposed.

This was the first time in his medical career that he felt utterly helpless with a patient. Even with previous patients who couldn’t be saved, he had at least known the root of the problem.

Liu Banxia went outside and asked the child, "Do you feel anything else when you sleep? Besides suddenly feeling drowsy and falling asleep, do you feel dizzy or uncomfortable when you wake up?"

The child shook his head. "No matter how long I sleep during the day, I can still sleep at night. Um... even if I don’t want to sleep, I probably end up doing so because of my body clock, like it’s a habit."

"What about his diet?" Liu Banxia followed up.

"I’m eating less oil and salt now, and more vegetables and fruits. I’m also worried about my blood pressure being so high, and it is high every time I measure it," the child replied.

"It must be the narcolepsy, Dad. Let’s just not worry about this anymore. We’ve been out for so long; Mom will call soon to check on us," the child said, turning to his father.

"Doctor, what do you suggest we do next?" the child’s father asked Liu Banxia.

"According to the recent blood test, the high blood pressure has already caused some damage to his kidneys. So, besides the narcolepsy, we also need to focus on the high blood pressure," Liu Banxia explained.

"It’s not easy to diagnose. High blood pressure can have many causes. It could also be a result of the narcolepsy; it’s hard to determine right now."

"I was hesitant about ordering more diagnostic tests. However, given the current situation, I think we should. Even if the results are the same as before, it’s better to do it for peace of mind."

"Do it, do it! I’ll go pay for it now. Please write up the order," said the child’s father.

The father was so cooperative. Liu Banxia, however, felt a sense of powerlessness. The man was full of hope now, likely fueled by Liu Haibing’s boasts about him. But what about after the tests were done? The greater the hope, the greater the potential disappointment.

The boy clearly resisted more testing, but seeing his father’s determination, he didn’t object.

"Sigh... Is there really no other way?" Liu Haibing asked.

Liu Banxia shook his head helplessly. Just as he was about to speak, his gaze fell upon the father and son heading off with the volunteer for the CT scan, and he froze.

Ignoring Liu Haibing, he immediately hurried after them.

"Doctor, is there something else?" asked the child’s father.

"Please wait a moment. Son, you walk ahead by yourself," Liu Banxia said to the boy.

The child glanced at him and walked a short distance ahead.

Liu Banxia’s face lit up. "Haven’t you noticed anything strange about the way he walks?"

"Doctor, is it strange?" the child’s father asked with a wry smile.

"Ever since he got sick, the boy hasn’t had a single happy day. He always walks so listlessly. What can we say? We can’t really get on his case about it."

"No, no, that’s not listlessness, it’s ataxia! There must be something wrong with his brain!" Liang Xiaolin, who had followed them, exclaimed, her voice tinged with excitement.

Liu Banxia smiled and nodded. "One manifestation of ataxia is an unsteady gait. If you look closely, his right heel is noticeably more worn down than his left."

"If it were just listless walking, the body’s natural balancing mechanism would mean that even if the wear on his shoes was uneven, the difference wouldn’t be so pronounced."

"Ataxia is often a sign of a cerebellar lesion. This means your son’s narcolepsy might have been a misdiagnosis! We’ll cancel the CT scan. I’m changing the order now to a head and neck MRI."

"Doctor, really? It’s really not narcolepsy?" the child’s father exclaimed, grabbing Liu Banxia’s arm.

"There’s a high probability. The boy’s current symptoms are quite consistent with Chiari malformation. It’s a bit complicated to explain, so let’s do the examination first," Liu Banxia said with an encouraging smile and nod.

"The reason it might have been missed is related to how the condition presented in him. One symptom of this illness is headaches, but he doesn’t experience them. It could be that he has a high pain tolerance, or perhaps the illness caused his blood pressure to rise, which in turn had an analgesic effect."

"Doctor Liang, please use my authorization to change the order. Also, when you take him to the MRI department, let them know our preliminary diagnosis so they can be extra thorough during the scan."

Liang Xiaolin nodded happily and started changing the order on the computer.

Now, it wasn’t just the child’s father; even the boy’s face showed a flicker of animation.

"President Liu, how did you figure that out?" Xu Hui asked, having heard the commotion and come out.

"I’m not certain yet; it’s just a hypothesis for now," Liu Banxia answered.

"We all overlooked one crucial point: his episodes of suddenly falling asleep are quite severe. We just assumed it was caused by narcolepsy."

"There was another symptom I noticed but didn’t mention: the boy snores intermittently in his sleep. I overlooked that."

"Sudden sleep attacks and snoring—these are somewhat different from typical narcolepsy and lean more towards Central Sleep Apnea Syndrome. Combined with his ataxia, I suspect it might be caused by Chiari malformation."

"Returning to Chiari malformation, its most prominent symptom is pain—usually a burning, radiating pain in the occipital area, neck, and arms."

"The boy doesn’t have these pain symptoms, which makes his case unusual. Instead of causing pain, it seems to have triggered Central Sleep Apnea Syndrome and sudden sleep attacks."

"Only a neurological cause could produce such an immediate effect, right? All his symptoms are tangled together now, making it very misleading."

"When we do CT scans, we focus on the brain. Who would think to specifically scan the cervical spine? I’ve never heard of narcolepsy being related to issues in the cervical vertebrae!"

Xu Hui nodded. "That makes sense. After hearing your explanation, it seems quite plausible. Otherwise, it’s hard to explain. While it might sound a bit unconventional, it fits this patient’s situation perfectly."

"It’s incredible how varied disease manifestations can be. The symptoms summarized in medical textbooks are often just the most common ones."

This praise was well-deserved. Liu Banxia’s diagnostic insight today was truly a stroke of genius. If confirmed, this case would undoubtedly be recorded as a classic in the annals of the Second Hospital.

Everyone then gathered around the computer, waiting for the MRI scan results.

DING! Task completed: The Curious Case of High Blood Pressure

Awarded: 500 Experience points, 500 Diagnostic Skill Proficiency Points, 5 Glory Points.

Task Rating: Perfect. Additional Award: 500 Experience points, 800 Diagnostic Skill Proficiency Points, 10 Glory Points.

Congratulations, Host! Level up to 43 (93,435/98,580 EXP). Acquired: 1 Attribute Point, 5 Glory Points.

Looking at the scan results, the diagnosis was confirmed. Liu Banxia hadn’t expected such generous rewards.

Amidst the joy, however, a small worry surfaced. While his diagnostic skill proficiency was increasing, he still had many surgical techniques to master.

Wound dressing changes, suturing techniques—these fundamental skills were what he urgently needed to improve.