There are many young and fearful colleagues like this. Dr. Liu lost his temper after seeing what happened to his colleague.
No matter what, Dr. Liu has been working for one year longer than classmate Li, and has had one more year of rice. He is relatively tolerant of young people with lower qualifications than himself.
Two people work together to examine the patient.
Dr. Li Qian said anxiously again: "It's strange, it seems to be fine."
When it comes to symptoms when a patient's brain is abnormal, the most familiar basic examination item is to check the patient's pupils.
Do all brain patients really have pupil problems?
Let’s first talk about the anatomy of the pupil.
The size of a normal person's pupil is about 2 to 5 mm, except for special people. After all, some people are born with weird growth patterns.
Pupil changes occur dynamically with the intensity of light and the ups and downs of sympathetic or parasympathetic nerve excitability.
The parasympathetic nerve that innervates the pupillary sphincter comes from the autoocular nerve. The sympathetic nerve circuit that controls the pupillary dilation muscle is relatively complex. The center goes to the hypothalamus, and the nerve path goes through the brainstem to the spinal cord to the cervical nerve circuit. When it comes back, it passes through the cavernous sinus in the skull and finally reaches the ophthalmic nerve.
From the above circuit, we can know that the pupil abnormality in the brainstem accident case mentioned in the previous article is based on anatomy. What most people do not expect is that an accident in the cervical nerve circuit can also cause pupillary abnormality.
Just saying this can make people imagine that pupil examination is a very complicated technology. Don't look at it like many clinicians are constantly checking patients' pupils. In fact, doctors who are not specialists don't know much about it.
For example, when the two neurosurgeons standing at the door looked at the two colleagues who were holding flashlights to shine into the patient's pupils, Dr. Song's expression was: blind.
Monitor Yue Wentong almost wanted to go over and pick up Mr. Li's brain: Why don't you go back to school and re-study? Don't embarrass me, the monitor of neurosurgery.
The doctor uses a flashlight to examine the patient's pupils. According to the textbook, it is a pupillary light reflex examination. What is used is the reaction of the pupil to the intensity of light mentioned above. When light shines on one pupil of a normal person, the person's bilateral pupils will produce a symmetrical contraction reaction. This is the pupillary light reflex.
The pupillary light reflex is divided into direct light reflex and indirect light reflex, based on the anatomical basis of the light reflex pathway.
The pupillary light reflex is divided into direct light reflex and indirect light reflex, based on the anatomical basis of the light reflex pathway.
as follows:
Light shining on the retina of a single eye triggers photoreceptor cells that transmit information to retinal ganglion cells, and then through the nerve fibers of the optic nerve and chiasmatic tract, passing through multiple parts of the brain and finally returning to the bilateral oculomotor nerves and entering the orbital ciliary ganglion. Innervation of the pupillary sphincter muscle leads to bilateral pupillary constriction.
The doctor's operation based on this basic theory should be: first shine the flashlight into the patient's unilateral eye, observe the direct light reflection of this eye, and at the same time observe the indirect light reflection of the other eye.
How did Mr. Li take the photo?
Hold a flashlight and shine it back and forth between the patient's pupils.
Is there anything wrong?
Can't be wrong.
There is an advanced pupil examination called RAPD examination, which is done like this.
But did you ask Mr. Li if he knew this was a RAPD examination?
Classmate Li said: "This patient has direct light reflex."
Forgive Mr. Li, he has never been to the Department of Neurosurgery and Neurology for internship, so he confused various specialized operations.
Not to mention, if you find it difficult to tell whether there is something wrong with the pupils of this patient, you should at least have some intelligence to know that you can try turning off the indoor headlights and check again.
Monitor Yue was so angry that he could not speak.
Thank you for your support, good night, dear friends~
(End of chapter)
