The Enhanced Doctor-Chapter 680 Encephalitis

"Teacher Liu, Teacher Liu, the child we admitted during the day has developed a situation."

It was nighttime, and Liu Banxia was sleeping soundly when he was abruptly awakened by Huang Bo.

Liu Banxia rubbed his face. "What’s wrong? Didn’t we give him a sedative? Wasn’t he sleeping well?"

"The child had a convulsion half an hour ago. After waking up, he started hallucinating," Huang Bo said quickly.

Liu Banxia instantly became alert. This was a serious issue.

When he arrived at the ward upstairs, Zhang Ping was also there, his brow furrowed.

"According to the follow-up EEG, his cerebral cortex was very active just now. After waking up, he experienced visual hallucinations again. We can basically rule out a concussion now," Zhang Ping said.

Liu Banxia nodded. "So, a brain CT first, then a lumbar puncture?"

"That’s more or less the plan. Let’s see how things turn out," Zhang Ping said.

Their moods were heavy. Having ruled out a concussion, the primary remaining possibility was encephalitis. There are many types of encephalitis, but none of them are easy to treat.

"Dr. Liu, what exactly is happening? I asked Dr. Zhang just now, but he wouldn’t tell me the truth," the child’s father asked anxiously.

"It’s not that we’re deliberately keeping things from you. We don’t have a definitive diagnosis yet, only suspicions," Liu Banxia said.

"Next, we need to perform a head MRI, which is more precise than a CT scan, to see if we can find anything. Then, we’ll do a lumbar puncture to analyze his cerebrospinal fluid."

"Let’s try not to panic. Even if it’s encephalitis, there are usually clues. Please try to recall carefully: were there any abnormalities before the child hit his head playing soccer? Anything like a sudden high fever?"

The child’s father shook his head. "He’s always been perfectly fine, nothing at all. Just one knock, and it caused encephalitis?"

"Let’s wait for the test results. Huang Bo, take the child for the MRI," Liu Banxia said.

Huang Bo nodded and quickly helped the nurse push the hospital bed towards the MRI room.

Liu Banxia and Zhang Ping went to the office after the lights in the ward were turned off. There were other patients in the room, and discussing the case there would disturb their rest.

"What type do you think it is?" Liu Banxia asked.

"My personal feeling is that it’s viral," Zhang Ping said.

"After we administered the sedative, the child initially slept well. It feels as though, once the child fell into a deep sleep, his brain misinterpreted the situation, thinking he was dying. So, it stimulated the neurons, causing his body to move."

"When the EEG began to show activity, I rushed to the ward. Initially, the child was only experiencing leg twitches and eye movements. However, due to the sedative, he didn’t wake up immediately."

"This is likely an instinctive bodily response, similar to how people gasp for air when their breathing is obstructed. The brain made this judgment and then released more signals, causing the child to convulse."

"However, the child hasn’t had a fever, so I believe we can temporarily rule out a teratoma. Also, given that the child has had a normal life previously, I think we can also exclude encephalitis caused by bacteria, fungi, etc."

"But the problem remains very serious. Even with viral encephalitis, this kind of sudden onset usually occurs in the summer, transmitted by mosquito bites."

"The weather has warmed up a bit recently, but there aren’t any mosquitoes yet. This makes tracing the source of infection quite difficult."

Liu Banxia nodded. "I reckon that’s about right. Let’s wait for the MRI results first, then get the lumbar puncture done and conduct a thorough examination."

"However, based on my current knowledge of encephalitis and similar conditions, this is the first time I’ve seen a case like this child’s. The absence of fever is particularly troublesome."

"Whatever virus is causing this, it’s very cunning. If we can’t identify it, we can’t provide targeted treatment. This might be the initial phase, and it will likely worsen."

"The last encephalitis patient I treated, the one who was allergic to an IUD—hers was caused by the herpes virus. But when I checked this child, the corners of his mouth were clean."

"It might be some form of chronic encephalitis with a long incubation period. That’s why the child didn’t exhibit any abnormalities before the onset."

"If so, tracing it becomes even more difficult. Crucially, the child has no prior medical history. Did you speak with them again tonight? Did they overlook anything?"

Zhang Ping shook his head helplessly. "We talked a lot. I also inquired about the child’s mother’s situation. It’s a blended family. The child’s father was previously a transport driver."

"He divorced the child’s biological mother when the boy was three, and remarried his current wife when the boy was five. However, their family is very close, and she treats him like her own son. They haven’t had children of their own because of this boy."

"But even so, she doesn’t say much. She still seems somewhat reserved, perhaps afraid of saying the wrong thing and affecting the whole family."

Liu Banxia frowned. No wonder she behaved that way. Normally, the mother is usually the most emotional one.

It’s truly not easy for her. She clearly cares a lot but is afraid of misspeaking in her anxiety. If that happened, it could genuinely damage their family relationship. People often say rash things when they’re agitated.

Whether it’s viral or bacterial, we must identify it to provide targeted treatment. Otherwise, for the child’s condition, broad-spectrum drugs will definitely be ineffective.

After waiting a little longer, the MRI results came back negative again.

"Brother Zhang, this situation is getting tricky. The only thing left is the lumbar puncture for a final check, right?" Liu Banxia asked.

Zhang Ping nodded. "There are no other options. Examining the cerebrospinal fluid is the simplest and most direct method. Any other tests would just be a waste of time."

"My assessment is that it’s the early stage of viral inflammation. Although it has already caused some degree of damage to the cranium, the lesion site is too small to be visible on an MRI."

"Additionally, the child is in a growth and development period, and this phase can also lead to some misinterpretations. Everyone’s growth progress is different, leading to different results."

"Alright, let your intern, Wang Linping, perform it then. Huang Bo and the others have already done it several times," Liu Banxia said.

Zhang Ping nodded. Since the patient has been transferred to my department, it’s natural for my intern to perform the procedure. This is considered one of the few surgical procedures in neurology, and the interns I supervise are capable.

"Teacher Zhang, Teacher Liu, the intracranial pressure is a bit high," Wang Linping said after the procedure.

"Once you’ve drawn the fluid, send it for lab analysis immediately," Zhang Ping instructed.

This finding also preliminarily confirmed Liu Banxia’s and his judgment: it was indeed encephalitis.

There are only a few factors that cause increased intracranial pressure. The first possible cause is an increase in the volume of intracranial contents, such as cerebral edema, hydrocephalus, increased cerebral blood volume, or intracranial inflammation.

The second possibility is space-occupying lesions within the cranium, which reduce intracranial space and naturally elevate intracranial pressure. However, the CT and MRI results did not support this.

The third possibility is congenital malformation, which could also be excluded based on the CT and MRI scans.

Based on the results of both scans, the only possibility that couldn’t be ruled out was intracranial inflammation. Although the patient didn’t exhibit many other obvious symptoms, this likelihood was very high.

The current situation was entirely consistent with their initial assessment. Moreover, the patient’s encephalitis was likely caused by some kind of chronic virus.

Often, acute conditions are relatively easy to manage; it’s these chronic illnesses that are truly vexing.

This is because they develop insidiously. By the time they are detected, a certain degree of symptoms has already manifested.

"Dr. Liu, once the lumbar puncture is done, will we know what the illness is? Can treatment begin immediately then?" the child’s father asked after the cerebrospinal fluid was sent for analysis.

Liu Banxia nodded. "There’s a very high probability we can detect it. In your son’s case, there seems to have been a degree of coincidence involved."

"I suspect that when he collided while heading the ball, there might have already been some inflammation in his brain, causing a delay in his reactions or some behavioral lag."

"So, based on the current situation, it’s likely caused by a chronic virus or bacterium. We will systematically investigate potential pathogens."

"Such chronic conditions are very difficult to detect during their development. It’s not just children; even adults might not notice them."

"The only silver lining is that it’s still in the developmental stage. Even though there aren’t as many indicative symptoms as in acute encephalitis, this gives us more time to conduct pathogen tests."

"Your child just had a lumbar puncture, so please stay by his side now; he’s probably very scared. We will notify you as soon as the results are available."

"Dr. Liu, our whole family is counting on you," the child’s father said.

"Please rest assured. Both Dr. Zhang and I will do our absolute best," Liu Banxia said earnestly.

After leaving the ward, Liu Banxia and Zhang Ping were both somewhat silent.

As he had often said, retroactively explaining a medical condition is often straightforward—you just match the symptoms to the diagnosis. However, the actual diagnostic process is far from easy.

He himself had almost misdiagnosed it as a concussion yesterday. It was only because the child’s symptoms were so peculiar—no fever, no headache, no dizziness, just night terrors—that he hadn’t.

Things had become truly troublesome now. Their hopes rested with the laboratory, hoping they could quickly identify the cause. Whether it was encephalitis, a teratoma, or something else, once a diagnosis was made, they could begin targeted treatment.