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The 3-minute reading column is updated once every two weeks, and highlights the wonderful cases of the past two weeks for everyone to learn and discuss
.
There are thunderous breakfast case studies for medical pulse nerves five working days a week, 3 short and succinct small cases every day, and 3 knowledge points every day
.
The collision of everyone's thoughts has produced countless sparks of wisdom.
They often wander in the group and gain new gains every day
.
Author: Lu Zhijie Case provided: Peng Tengming, Li Shenjie, Zhang Leguo, Qiu Xilin, Wan Chuanyi, Yu Yancai, Guo Guixiang, Zhang Wensheng, Gu Hongli, Liu Xi, Tong Yongtang, Ma Guozhong, Liu Bo, Tang Siming, Du Qing, Lu Zhiyu, Dong Caixia, Zhang Hui, Li Jing, Song Guijun, and Lv Zhiyu Case 1 male patient, 50 years old, chief complaint: a mass on the left frontal and temporal area was found for more than 4 months
.
There was a history of trauma to this site 10 years ago
.
Diagnosis: Brain abscess (pathological) Case discussion: The image shows a subcutaneous cystic space on the right frontal area, which is "mushroom-like", the skull is eroded and destroyed, and invades the dura mater, ring-enhanced, and partitioned inside
.
Restricted diffusion of cyst fluid indicates the possibility of an abscess
.
It needs to be differentiated from skull eosinophilic granuloma, metastatic tumor, myeloma and other lesions that damage the skull
.
Eosinophilic granulomas usually have no fever and no discharge, and are more common in children and adolescents
.
MRI is a mass rather than cystic, and DWI without limitation of diffusion can be distinguished from an abscess
.
Case 2 is a 23-year-old male with left limb weakness for more than 4 months
.
MRI of the head showed that there is a cystic space in the right basal ganglia with fluid level inside
.
Diagnosis: Brain cyst with hemorrhage (pathology) Case discussion: The surgical pathology of this case is cyst with hemorrhage
.
However, primary basal ganglia cysts are rare.
In addition, the cyst itself is not common, and if it is internal hemorrhage, it should rarely cause clinical symptoms
.
Therefore, this case is somewhat controversial
.
Teachers in many groups believe that tension hematoma needs to be considered
.
Of course, more medical history support is needed
.
Case 3 is a 56-year-old female patient with persistent numbness in her hands for half a month and normal diet
.
Cervical MRI showed: C2-6 long-segment intramedullary disease, axial position showed "inverted V sign"
.
Supplementary medical history: Surgery for gastric stromal tumor was performed in 2014
.
Blood test prompts: giant cell anemia
.
Vitamin B12: 15.
3 (133-675) Diagnosis: Case discussion of subacute combined degeneration of spinal cord: This case is the differential diagnosis of long-segment spinal cord disease
.
The sagittal position can locate the segment longitudinally, and the axial position can clarify the extent of lateral injury such as transverse, hemisection, symmetrical damage, etc.
, so as to infer the nature of the disease
.
For example, NMOSD is mostly transverse lesions, MS is mostly eccentric focal or hemisection lesions, sarcoidosis is trident-like, subacute combined degeneration is inverted V sign or anti-rabbit ear sign as shown in this case, and anterior artery infarction is present Snake eye sign and so on
.
Case: A 457-year-old female was admitted to the hospital due to "repeated dizziness for half a month"
.
Half a month ago, the patient began to feel dizzy without any obvious cause.
For the first time, he showed a sense of turning around and then showing paroxysmal drowsiness, no headache, no tinnitus, and hearing loss
.
The past medical history is nothing special
.
MRI showed extensive thickening of the dura mater with obvious enhancement
.
The high cervical spinal cord is tortuous and swollen
.
Supplementary medical history: The dizziness is obvious after sitting for a long time, and it can be relieved after lying down
.
Lumbar puncture cerebrospinal fluid pressure <50mmH2O
.
Diagnosis: Low intracranial pressure syndrome case discussion: The main manifestation of low intracranial pressure is headache.
This case is mainly manifested as dizziness, which is somewhat confusing.
It is easy to be misdiagnosed as otolithiasis and other diseases caused by postural changes
.
The image gave us a lot of clues
.
The imaging manifestations of low intracranial pressure can be abbreviated as SEEPS (meaning leakage): Subdural fluid collections: Subdural fluid collections Enhancement of the pachymeninges: Dural enhancement Venous Engorgement: Venous expansion Pituitary hyperemia: Pituitary hyperemia: Sagging of the brain: Under the brain Case Shen, a 566-year-old female patient, was admitted to the hospital for “being found to have changed her mind for 13 hours”
.
Previous diabetes, history of toe amputation on the second toe of the left foot
.
Physical examination: 37.
7℃, confusion, aphasia, uncooperative examination, slight neck resistance, bilateral pupils of equal size, sensitive to light reflection, no gaze in the eyes, uncooperative limb muscle strength examination, no obvious response to pain and stimulation
.
No bilateral pathological signs were elicited
.
MRI showed limited diffusion of the bridge arms on both sides
.
Supplementary examination: emergency check of peripheral blood glucose 2.
2mmol/L Diagnosis: hypoglycemic encephalopathy
.
Hypoglycemic encephalopathy can occur at any age.
It is more common in middle-aged and elderly people with a history of diabetes and blood sugar-lowering drugs.
It often occurs in patients with overdose of insulin with blood sugar levels below 2.
8mmol/L (50 mg/dl).
People have poor tolerance to hypoglycemic drugs, especially sulfonylureas
.
It can also be seen in patients with alcoholism, diet to lose weight, hunger, and islet cell tumor
.
Hypoglycemic encephalopathy often involves the cerebral cortex and gray matter in the basal ganglia, as well as areas with dense nerve fibers such as the internal capsule, corpus callosum, and cerebellar midfoot.
The imaging studies are mostly non-characteristic, and the diagnosis can be diagnosed in combination with medical history
.
The causes of bilateral bridge arm disease are complex, involving almost all CNS diseases such as cerebrovascular diseases, neurodegenerative diseases, and demyelinating diseases
.
Some systemic diseases, including endocrine and metabolic diseases, poisoning, infection and other diseases, can also cause secondary bridge damage
.
Hypoglycemic encephalopathy is mostly acute onset, manifested as neurological deficits, and is one of the primary differential diagnosis of stroke-like diseases
.
Case 6 is a 13-year-old female patient with left upper limb weakness for one month
.
MRI of the head showed short T1 and long T2 signals in the basal ganglia on both sides, mainly in the right striatum
.
SWI shows the deposition of paramagnetic material, and the enhancement shows irregular ring enhancement and slight cystic changes
.
The right lateral ventricle was slightly enlarged, and the lateral fissure deepened
.
Prompt negative placeholder
.
Diagnosis: Intracranial germ cell tumor (pathologically confirmed after surgery, no pathological results) Intracranial germ cell tumor: is a rare intracranial malignant tumor, accounting for 2% to 3% of all childhood tumors, with an incidence of about 3.
5% It is more common in adolescents and children.
It is rare in the elderly and young children.
It usually occurs in midline areas such as sellar area and pineal area.
10% can also occur in non-midline areas such as thalamus and basal ganglia
.
SWI is of great value for identifying early germ cell tumors in the basal ganglia (early tumor microhemorrhage)
.
T1 high signal and SWI low signal still need to be differentiated from hepatolenticular degeneration, which has no obvious enhancement and is not accompanied by brain atrophy
.
.
There are thunderous breakfast case studies for medical pulse nerves five working days a week, 3 short and succinct small cases every day, and 3 knowledge points every day
.
The collision of everyone's thoughts has produced countless sparks of wisdom.
They often wander in the group and gain new gains every day
.
Author: Lu Zhijie Case provided: Peng Tengming, Li Shenjie, Zhang Leguo, Qiu Xilin, Wan Chuanyi, Yu Yancai, Guo Guixiang, Zhang Wensheng, Gu Hongli, Liu Xi, Tong Yongtang, Ma Guozhong, Liu Bo, Tang Siming, Du Qing, Lu Zhiyu, Dong Caixia, Zhang Hui, Li Jing, Song Guijun, and Lv Zhiyu Case 1 male patient, 50 years old, chief complaint: a mass on the left frontal and temporal area was found for more than 4 months
.
There was a history of trauma to this site 10 years ago
.
Diagnosis: Brain abscess (pathological) Case discussion: The image shows a subcutaneous cystic space on the right frontal area, which is "mushroom-like", the skull is eroded and destroyed, and invades the dura mater, ring-enhanced, and partitioned inside
.
Restricted diffusion of cyst fluid indicates the possibility of an abscess
.
It needs to be differentiated from skull eosinophilic granuloma, metastatic tumor, myeloma and other lesions that damage the skull
.
Eosinophilic granulomas usually have no fever and no discharge, and are more common in children and adolescents
.
MRI is a mass rather than cystic, and DWI without limitation of diffusion can be distinguished from an abscess
.
Case 2 is a 23-year-old male with left limb weakness for more than 4 months
.
MRI of the head showed that there is a cystic space in the right basal ganglia with fluid level inside
.
Diagnosis: Brain cyst with hemorrhage (pathology) Case discussion: The surgical pathology of this case is cyst with hemorrhage
.
However, primary basal ganglia cysts are rare.
In addition, the cyst itself is not common, and if it is internal hemorrhage, it should rarely cause clinical symptoms
.
Therefore, this case is somewhat controversial
.
Teachers in many groups believe that tension hematoma needs to be considered
.
Of course, more medical history support is needed
.
Case 3 is a 56-year-old female patient with persistent numbness in her hands for half a month and normal diet
.
Cervical MRI showed: C2-6 long-segment intramedullary disease, axial position showed "inverted V sign"
.
Supplementary medical history: Surgery for gastric stromal tumor was performed in 2014
.
Blood test prompts: giant cell anemia
.
Vitamin B12: 15.
3 (133-675) Diagnosis: Case discussion of subacute combined degeneration of spinal cord: This case is the differential diagnosis of long-segment spinal cord disease
.
The sagittal position can locate the segment longitudinally, and the axial position can clarify the extent of lateral injury such as transverse, hemisection, symmetrical damage, etc.
, so as to infer the nature of the disease
.
For example, NMOSD is mostly transverse lesions, MS is mostly eccentric focal or hemisection lesions, sarcoidosis is trident-like, subacute combined degeneration is inverted V sign or anti-rabbit ear sign as shown in this case, and anterior artery infarction is present Snake eye sign and so on
.
Case: A 457-year-old female was admitted to the hospital due to "repeated dizziness for half a month"
.
Half a month ago, the patient began to feel dizzy without any obvious cause.
For the first time, he showed a sense of turning around and then showing paroxysmal drowsiness, no headache, no tinnitus, and hearing loss
.
The past medical history is nothing special
.
MRI showed extensive thickening of the dura mater with obvious enhancement
.
The high cervical spinal cord is tortuous and swollen
.
Supplementary medical history: The dizziness is obvious after sitting for a long time, and it can be relieved after lying down
.
Lumbar puncture cerebrospinal fluid pressure <50mmH2O
.
Diagnosis: Low intracranial pressure syndrome case discussion: The main manifestation of low intracranial pressure is headache.
This case is mainly manifested as dizziness, which is somewhat confusing.
It is easy to be misdiagnosed as otolithiasis and other diseases caused by postural changes
.
The image gave us a lot of clues
.
The imaging manifestations of low intracranial pressure can be abbreviated as SEEPS (meaning leakage): Subdural fluid collections: Subdural fluid collections Enhancement of the pachymeninges: Dural enhancement Venous Engorgement: Venous expansion Pituitary hyperemia: Pituitary hyperemia: Sagging of the brain: Under the brain Case Shen, a 566-year-old female patient, was admitted to the hospital for “being found to have changed her mind for 13 hours”
.
Previous diabetes, history of toe amputation on the second toe of the left foot
.
Physical examination: 37.
7℃, confusion, aphasia, uncooperative examination, slight neck resistance, bilateral pupils of equal size, sensitive to light reflection, no gaze in the eyes, uncooperative limb muscle strength examination, no obvious response to pain and stimulation
.
No bilateral pathological signs were elicited
.
MRI showed limited diffusion of the bridge arms on both sides
.
Supplementary examination: emergency check of peripheral blood glucose 2.
2mmol/L Diagnosis: hypoglycemic encephalopathy
.
Hypoglycemic encephalopathy can occur at any age.
It is more common in middle-aged and elderly people with a history of diabetes and blood sugar-lowering drugs.
It often occurs in patients with overdose of insulin with blood sugar levels below 2.
8mmol/L (50 mg/dl).
People have poor tolerance to hypoglycemic drugs, especially sulfonylureas
.
It can also be seen in patients with alcoholism, diet to lose weight, hunger, and islet cell tumor
.
Hypoglycemic encephalopathy often involves the cerebral cortex and gray matter in the basal ganglia, as well as areas with dense nerve fibers such as the internal capsule, corpus callosum, and cerebellar midfoot.
The imaging studies are mostly non-characteristic, and the diagnosis can be diagnosed in combination with medical history
.
The causes of bilateral bridge arm disease are complex, involving almost all CNS diseases such as cerebrovascular diseases, neurodegenerative diseases, and demyelinating diseases
.
Some systemic diseases, including endocrine and metabolic diseases, poisoning, infection and other diseases, can also cause secondary bridge damage
.
Hypoglycemic encephalopathy is mostly acute onset, manifested as neurological deficits, and is one of the primary differential diagnosis of stroke-like diseases
.
Case 6 is a 13-year-old female patient with left upper limb weakness for one month
.
MRI of the head showed short T1 and long T2 signals in the basal ganglia on both sides, mainly in the right striatum
.
SWI shows the deposition of paramagnetic material, and the enhancement shows irregular ring enhancement and slight cystic changes
.
The right lateral ventricle was slightly enlarged, and the lateral fissure deepened
.
Prompt negative placeholder
.
Diagnosis: Intracranial germ cell tumor (pathologically confirmed after surgery, no pathological results) Intracranial germ cell tumor: is a rare intracranial malignant tumor, accounting for 2% to 3% of all childhood tumors, with an incidence of about 3.
5% It is more common in adolescents and children.
It is rare in the elderly and young children.
It usually occurs in midline areas such as sellar area and pineal area.
10% can also occur in non-midline areas such as thalamus and basal ganglia
.
SWI is of great value for identifying early germ cell tumors in the basal ganglia (early tumor microhemorrhage)
.
T1 high signal and SWI low signal still need to be differentiated from hepatolenticular degeneration, which has no obvious enhancement and is not accompanied by brain atrophy
.
