Chapter 4104 [193] Confused

There are many such young and timid colleagues, and Dr. Liu loses his temper after seeing what is going on with this partner.

In any case, Dr. Liu has practiced for one year longer than his classmate Li, and has eaten a year more rice. His mentality is more tolerant of young people with lower qualifications than himself.

The two worked together to examine the patient.

Doctor Li Qi'an said anxiously again: "It's strange, it seems to be all right."

When it comes to the symptoms of abnormalities in the patient's brain, the most familiar basic inspection item is to check the patient's pupils.

In fact, is it true that all brain patients must have pupil problems?

Let's talk about the anatomy of the pupil first.

The pupil size of normal people is about 2 to 5 mm, except for special people. After all, some are naturally born to be more wonderful.

The change of the pupil is a dynamic change with the intensity of the light and the excitability of the sympathetic or parasympathetic nerves.

The parasympathetic nerve that innervates the pupillary sphincter comes from the ophthalmic nerve. The sympathetic nerve circuit that controls the pupillary dilator muscle is relatively complicated. The center goes to the hypothalamus, and the nerve path sent out passes through the brainstem to the spinal cord to the cervical nerve circuit. When it comes back, it passes through the intracranial cavernous sinus and finally reaches the ophthalmic nerve.

From the circuit above, we can know that the pupil abnormality in the case of the brainstem accident mentioned in the previous article has an anatomical basis. What most people did not expect is that the accident in the neck nerve circuit can also cause pupil abnormality.

Just saying this can make people imagine that pupil inspection is a very complicated technology. Don't look at the fact that many clinicians often take pictures of patients' pupils to check. 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 holding flashlights to illuminate the patient's pupils, Dr. Song's expression was: no eyes.

The class monitor Yue Wentong almost wanted to go over and pick up classmate Li's brain: you fucking go back to school and re-read, don't embarrass me, the neurosurgery class monitor.

The doctor's flashlight shines on the patient's pupils for inspection. The textbook says to do pupillary light reflex inspection. It uses the pupil’s response to the intensity of light mentioned above. When the light shines on one pupil of a normal person, the pupils on both sides of the person will produce a symmetrical contraction reaction, which is the pupil’s reflection of light.

The pupillary light reflex is divided into direct light reflex and indirect light reflex, and the anatomical basis is the light reflex pathway.

The pupillary light reflex is divided into direct light reflex and indirect light reflex, and the anatomical basis is the light reflex pathway.

as follows:

Light irradiates on the retina of one eye to trigger photoreceptor cells to transmit information to retinal ganglion cells, and then pass through the optic nerve optic chiasm part of the nerve fibers all the way through multiple parts of the brain, and finally return to the bilateral oculomotor nerves and enter the orbital ciliary ganglion Innervation of the pupillary sphincter ensues bilateral pupillary constriction.

The doctor's operation based on this basic theory should be: first illuminate the patient's one eye with the flashlight, observe the direct light reflex of this eye, and observe the indirect light reflex of the other eye at the same time.

How did classmate Li take the picture?

Take a flashlight and shine it back and forth between the patient's two pupils.

Is there something wrong?

Can't be wrong.

There is such an advanced examination for pupil examination, called RAPD examination, which is taken in this way.

But you asked Li, does he know that this is a RAPD test?

Classmate Li said: "This patient has direct light reflexes."

Forgive Mr. Li, he has never been to the Department of Neurosurgery and Neurology for an internship, so he confuses the operations of various specialties.

Not to mention, if this patient finds it difficult to distinguish whether there is something wrong with the pupil, at least you should have a little intelligence to know that you can try to turn off the indoor headlights and check again.

Squad leader Yue was too angry to speak.

Thank you for your support, good night, dear~