Chapter 1913: 1846 Intelligence 'Game' (Monthly Ticket 33000 Bonus ×66)

We can't say that; we've at least ruled out several possibilities. Zheng Ren's expression was as serious as when Su Yun and Zhou Litao had been teaching and clearing up doubts just before.

What are we considering now?

What fits best is probably formaldehyde poisoning. Zheng Ren said: Mild poisoning causes blurred vision, dizziness, headache, fatigue and other systemic symptoms. Severe poisoning can lead to pulmonary edema, and hypoxia can also cause convulsions and other symptoms.

Not likely. Su Yun shook her finger: First, after leaving a toxic environment, formaldehyde poisoning rarely progresses. We're not saying it would directly resolve and become fine, but going from loss of smell to spasms is unlikely.

Zheng Ren also felt this diagnosis was a bit forced; Su Yun's judgment was correct.

He continued to ponder, his finger lightly tapping the desk. Su Yun thought that if this guy grew old, he'd be like Director Pan.

Or perhaps he's intentionally or unintentionally imitating Director Pan.

It's not formaldehyde poisoning, not sulfur dioxide poisoning, could it be an intracranial tumor? This possibility... Zheng Ren mused, speaking softly.

Do you also mutter that out loud during exams? Annoying, isn't it? Su Yun said disparagingly, Why don't you bring your Fifth Edition of External Medicine to future hospital meetings and recite it section by section?

Hmm... Zheng Ren seemed not to have heard Su Yun's mockery, continuing to ponder: Besides, there's hallucination. One feels unable to smell, then suddenly has a seizure.

You could go write fantasy novels. If such a situation existed, it wouldn't show up early or late—it would have to appear in the CT room, which is nonsense. Su Yun said.

If we take that term to mean epilepsy, would it be better? For example, reflex epilepsy syndrome.

Almost all seizures are triggered by specific sensations or complex cognitive activities, such as reading epilepsy, startle epilepsy, visually reflex epilepsy, hot-bath epilepsy, card-playing epilepsy, etc. Remove the trigger and the seizures cease.

You mean...? Su Yun also became doubtful.

Claustrophobia usually becomes apparent during an MRI, but some patients develop it during a CT scan, in SCI...

Stop showing off your data; epilepsy might be possible, but can it explain loss of smell? Su Yun kept picking at flaws.

Indeed, Su Yun was right.

This is like pressing down a gourd only for a ladle to pop up—loss of smell and epilepsy just don't go together.

Besides, claustrophobia is rare.

Zheng Ren let out a breath and continued thinking.

Heh heh, want me to go ask about other medical histories? Su Yun said with a chuckle.

Go find Zhou Litao?

Who knows? Let's first ask the little nurse; maybe she can provide useful information.

If you want to go idle, go; don't drag the pretext of asking about medical history. Zheng Ren said: Actually, epilepsy and loss of smell can be linked.

For example?

Antihypertensive drugs can improve heart function and occasionally damage the olfactory nerve.

That's too far-fetched.

Abnormal neuronal discharge in brain cells... nerve damage... Zheng Ren began muttering again.

Don't think that by saying epilepsy is abnormal neuronal discharge in brain cells you'll seem more professional. Su Yun said.

Not like that... Zheng Ren raised his hand and said: Nerve damage doesn't have to be from trauma; other factors can also cause nerve damage.

Tumor invasion, diffused chemical elements in the air—what else do you want to say? We've just ruled those out. Su Yun said.

Parasites, for example amoebas, first enter the human nasal cavity, are taken up via phagocytosis through the supporting cells of the olfactory epithelium, then travel along the axon sheath of the unmyelinated olfactory nerve fibers, pass through the cribriform plate, and reach...

Zheng Ren said this, and then he himself froze.

Su Yun's gaze also showed some doubt; he looked at Zheng Ren in surprise.

He had wanted to rebut, but primary amoebic meningoencephalitis indeed causes loss of smell and also has seizure symptoms. The words rose to his lips, but Su Yun swallowed them back.

Uh...

It's primary amoebic meningoencephalitis! Zheng Ren said, then added: This diagnosis is fairly reliable, with an 80% probability!

Primary amoebic meningoencephalitis? How does it get in?

Ask Manager Zhou whether the patient has any wound near the nose. Also, how old is the patient? It could be that a pimple was popped, letting in amoebas.

The more Zheng Ren spoke, the more confident he became.

Because the earlier diagnoses were too obviously flawed, any basic logic could rule them out. They belong to differential diagnosis, sacrificial diagnoses that are rejected after reasons are found.

At first there was olfactory abnormality, then dizziness, headache, nausea, projectile vomiting, and only later seizures. Su Yun frowned, offering a reason he himself wasn't entirely sure of.

Depending on where the infection occurs, the disease progression could become interleaved. Zheng Ren said: The condition is very complex; the textbook steps are just one likely outcome.

Sure enough, Su Yun's words were immediately rebutted by Zheng Ren.

Zheng Ren then picked up his phone and made a call.

But the phone rang at the door; Zhou Litao then came in, pushing the door open while holding his phone.

Boss Zheng, Brother Yun, sorry about that—the patient had a sudden situation, so I'm late getting back. Zhou Litao said apologetically.

Does the patient have any trauma to the nasolabial triangle? Zheng Ren asked directly.

Uh... none. Zhou Litao said, No trauma.

Zheng Ren was a bit disappointed, but immediately asked: How old is the patient?

A man in his sixties. Zhou Litao replied instinctively.

Could I have been wrong?

Boss Zheng, what disease are you considering? Zhou Litao saw Zheng Ren's grim expression and asked cautiously.

No trauma? What about rhinophyma?

Uh... Zhou Litao paused, wondering what was wrong with Boss Zheng.

He has rhinophyma, drinks heavily year-round; for now we're considering alcohol-induced convulsions. Zhou Litao added quickly, so Zheng Ren wouldn't keep hounding him.

No! It's primary amoebic meningoencephalitis. Zheng Ren said: Put the patient under sedation, rush the CT. Also, do a cerebrospinal fluid exam.

""

Zhou Litao had just been sweating from work, then came back and was completely bewildered by Zheng Ren's head-on barrage, even more confused than when Su Yun had been teaching and clearing up doubts earlier.

"Rhinophyma, when in contact with raw water, has an extremely low probability of developing an Amoeba infection. The incubation period is short, and it flares up suddenly." Zheng Ren said more definitively: "Have the doctors in the Inpatient Department immediately check the cerebrospinal fluid, then do a CT."