Chapter 2067: Chapter 1785: Still Missing One Link (2)

Yang Ping flipped to the page on coagulation function and suddenly paused.

Zhaxi followed his gaze to a D-dimer test sheet, checked the day of admission, with values five times higher than normal.

Yang Ping stared at the number, silent for a moment, then continued flipping.

He flipped to the brain angiography report on the second day of admission and looked at it for a long time. The report read: "Saccular aneurysm at the distal branch of the right middle cerebral artery, approximately 8mm×6mm, irregular shape."

He then flipped to the CT report: "Right temporal lobe intracerebral hematoma, about 40ml, ruptured into the subarachnoid space."

Yang Ping placed the report down, leaned back in his chair, and was silent for a long time.

Director Tian cautiously asked, "Professor Yang, is there a problem?"

Yang Ping did not answer directly and instead said, "The location of this aneurysm is a bit interesting."

"Location?" Doctor Meng leaned over to look at the film, "It’s a bit far, not at the bifurcation. But occasionally encountered, right?"

Yang Ping shook his head, not speaking further, as if pondering the matter.

A moment later, Yang Ping asked, "Have the infection indicators been checked?"

"Checked, blood cultures were done twice, both negative. Surface ultrasound of the heart was also done, no vegetations seen." Doctor Meng said, "We also considered the possibility of infectious aneurysm but couldn’t find the infection source."

Yang Ping nodded, asking no further. He glanced at his watch and said, "That’s it for today, I’ll come back tomorrow. With the family, continue communicating, but do not rush the surgery."

Doctor Meng hesitated, clearly not expecting Yang Ping to leave, but nodded, "Alright, thank you, Professor Yang."

As they exited the Overseas Chinese Building, Zhaxi couldn’t help but ask, "Professor Yang, do you think there’s a problem with that aneurysm?"

Yang Ping looked at him without answering, counter-questioning, "What do you think?"

Zhaxi thought for a moment, saying, "The location is a bit odd, but Doctor Meng said all infection indicators are normal..."

Yang Ping interrupted him, "All normal doesn’t mean there’s no problem. Sometimes, the issue lurks within ’all normal’. All normal itself can be abnormal."

He didn’t explain further, quickening his steps towards the Operating Room: "Have surgery this afternoon, let’s go."

That afternoon, Zhaxi accompanied Yang Ping for two spinal surgeries.

After busying themselves, Zhaxi pondered over the case in the Overseas Chinese Building, a strange location, but normal infection indicators, why did Yang Ping still ask?

He couldn’t figure it out.

The next morning, Zhaxi appeared in the office at six as usual, browsing through new examination results of the cases in Corey and reviewing all medical records, Yang Ping directed him to join the rounds in the Neurology Department.

Morning rounds started at eight, more than ten doctors circled around, the director, being a professor in his forties named Zhou, spoke calmly. Upon reaching a patient, Zhaxi suddenly perked his ears up.

It was a woman in her fifties admitted for recurrent headaches. After much investigation, it was discovered to be intracranial infection. Professor Zhou asked the physician in charge, "Found the source of infection?"

The physician in charge said, "No, blood culture is negative, cerebrospinal fluid culture is also negative."

Professor Zhou nodded, silent for a few seconds, then said, "Sometimes, not finding the infection source doesn’t mean there’s no infection. You need to think from another angle, the infection might not be in the brain but elsewhere. Intestinal tract, teeth, sinuses, all are possible."

Zhaxi’s heart stirred.

After rounds, he caught up with the old professor, mustering the courage to ask, "Professor Zhou, I’m wondering, can intestinal infection cause intracranial issues?"

The old professor glanced at him, recognized him as a student in the training class, for whom Professor Yang had specially called him yesterday, saying to let this student join the rounds, Professor Zhou nodded: "It can! Intestinal flora disorder, bacteria entering the bloodstream, can lead to brain abscess, meningitis, even infectious aneurysm." He paused, "Why, encountered a difficult case?"

Zhaxi nodded, briefly recounting the case in the Overseas Chinese Building.

After listening, Professor Zhou thoughtfully said, "Aneurysm in a strange location, long-term diarrhea, used antibiotics, low-grade fever, electrolyte disorder..." He pondered for a few seconds, "Interesting, what’s your Professor Yang’s view?"

Zhaxi said, "Professor Yang went for consultation yesterday, didn’t say much, just said ’the location is a bit interesting,’ then had me come to join your rounds."

Professor Zhou laughed, "He’s aware, just not saying." He patted Zhaxi’s shoulder, "Follow him and learn well, cases like this, there’s knowledge to be gained."

Zhaxi’s heart jolted.

In the afternoon, Zhaxi found two classmates from the same dormitory, recounting the case from the Overseas Chinese Building.

"Infectious aneurysm?" one classmate frowned, "But the blood culture is negative."

"I know." Zhaxi said, "But the location is really strange, and the patient has so many oddities, diarrhea, low-grade fever, hypokalemia, hyponatremia, had used antibiotics, when combined, I feel it’s not coincidental."

Another classmate asked, "What did Professor Yang say?" 𝒇𝓻𝓮𝓮𝙬𝙚𝒃𝒏𝓸𝙫𝒆𝙡.𝓬𝓸𝒎

Zhaxi shook his head, "He didn’t say anything, just mentioned coming back tomorrow."

Ely thought for a moment, saying, "How about we check the literature ourselves?"

Zhaxi’s eyes lit up, "Good idea."

That night, the three of them surfed the literature on computers in the dorm until dawn. Zhaxi’s computer displayed seven or eight web pages, all containing papers on infectious aneurysm.

"Look at this." Zhaxi pointed at the screen, "A review states that the most common pathogens for infectious aneurysms are streptococcus and staphylococcus, but they can also be caused by intestinal bacteria, like salmonella, Clostridium difficile..."

"Clostridium difficile?" a classmate leaned over, "What’s that?"

"A type of opportunistic pathogenic bacteria in the intestinal tract, prone to infecting people who have long used antibiotics." Zhaxi read from the literature, "Symptoms include diarrhea, low-grade fever, weight loss, electrolyte disorder..."