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18
Tang Li Li
Neurology
About me
Deputy Chief Physician, currently pursuing a PhD degree, with 13 years of working experience in a top-tier hospital. Have received advanced training and study at Erlangen University Hospital in Germany and Magdeburg University Hospital. Research focus on neuroinflammation and immune-related diseases.
Proficient in diseases
Headache, dizziness, insomnia, anxiety, epilepsy, cerebral infarction, cerebral hemorrhage, inadequate cerebral blood supply, as well as inflammation and autoimmune diseases of the nervous system such as encephalitis, myasthenia gravis, and Guillain-Barré syndrome.
Voices
Can encephalitis recur?
Encephalitis comes in various types, some of which are prone to recurrence, while others are monophasic and do not recur. The most common type is viral encephalitis, particularly infections caused by the herpes simplex virus. Although recovery from viral encephalitis after antiviral treatment is possible, it may leave some sequelae, but generally does not recur. Tuberculous meningoencephalitis, however, has a higher rate of recurrence, often related to the resistance of tuberculosis bacteria and inadequate anti-tuberculosis treatment. Patients need repeated lumbar puncture tests to confirm that the cerebrospinal fluid has returned to normal levels and require long-term use of anti-tuberculosis medications. Bacterial meningitis generally does not recur. Additionally, there are some autoimmune types of encephalitis, such as autoimmune encephalitis, multiple sclerosis, and neuromyelitis optica, where recurrence is possible when involving the brain.
Methods for Examining Dementia in the Elderly
The examination of dementia mainly includes the following aspects. First, it is to determine whether the patient has cognitive impairment, because in the early stages of dementia this impairment is often mild, primarily in recent memory, with other aspects not yet obvious. Early screening can use some cognitive evaluation scales, such as the Mini-Mental State Examination or the Montreal Cognitive Assessment, chosen according to the patient's cultural level. Second, imaging examination, commonly using brain MRI, can reveal significant signs of dementia such as deepened brain sulci, narrowed gyri, and widened lateral fissures, indicating brain atrophy. Third, genetic testing for the APOE gene, which may be related to dementia. Possession of this gene may increase the likelihood of developing dementia in the future, serving as an auxiliary diagnostic measure.
Is hydrocephalus serious?
Hydrocephalus is a relatively severe neurological disorder, generally caused by disturbances in cerebrospinal fluid (CSF) circulation, leading to obstructive hydrocephalus due to blocked circulation pathways. Other causes include overproduction of CSF or reduced absorption, which can also lead to hydrocephalus. If the volume of hydrocephalus is not large, the clinical symptoms are generally not obvious, and the patient may only experience dizziness, slow response, cognitive impairment, and unstable walking. If the hydrocephalus is significant, it often causes severe compression of brain tissue, which can lead to consciousness disturbances, progressive dementia, epileptic seizures, and incontinence. Timely surgical intervention is necessary to relieve the pressure caused by the edema.
What department should one go to for a cerebral embolism?
Patients with cerebral embolism should visit the department of neurology. Cerebral embolism is not a special disease but rather one type of cerebral infarction. Cerebral infarction generally includes two types: cerebral thrombosis and cerebral embolism. The former refers to the formation of a thrombus at the site of the vessel occlusion. The latter involves a thrombus originating from another location, which blocks the vessel at the infarct site. The sources of such thrombi are varied, with the most common being from the heart, frequently seen in patients with long-term chronic atrial fibrillation. This condition forms a mural thrombus in the atrium, which, during episodes of atrial fibrillation, can detach, be flushed by the blood stream into the brain, and cause cerebral embolism. Secondly, it occurs in cardiac valve diseases, such as rheumatic heart disease, mitral valve alterations, and others. There are also some other sources of thrombi, such as tumor-induced cancer, amniotic fluid embolism in pregnant women, and fat embolism in patients with fractures.
How to Treat Facial Neuritis
Bell's palsy, once diagnosed, needs to be treated as early as possible, with better outcomes the earlier treatment is started. If the patient does not have any significant contraindications, corticosteroids should be used in the early stages. Common treatments include oral prednisone, typically for about ten days, or dexamethasone intravenous infusion, typically for about five to seven days. Alongside anti-inflammatory corticosteroids, nerve nourishment can be addressed with muscle injections of vitamin B1 and vitamin B12, and patients with better economic conditions can also use mouse nerve growth factor for muscle injection nerve nourishment. Additionally, if the patient has significant pain behind the ear, indicating a possible viral infection, concurrent treatment with acyclovir antiviral therapy should be administered. Later, if recovery is poor, rehabilitative treatment can be provided, including electro-acupuncture physical therapy, infrared magnetic heating, etc., all of which can promote the recovery of Bell's palsy. The overall treatment course approximately takes about 20 days, with total recovery time ranging from 20 days to two months. (Note: Medication should be used under the guidance of a physician, based on the actual conditions.)
Is cerebral hemorrhage dangerous?
Cerebral hemorrhage is a type of acute cerebrovascular accident and is quite dangerous. The risk associated with cerebral hemorrhage is directly related to the amount of bleeding and the location of the bleed. Generally, if it is an ordinary lobar hemorrhage and the volume of blood is less than 30 milliliters, the risk is relatively low, and conservative medical treatment may be sufficient. However, if the bleeding exceeds 30 milliliters, there is an indication for surgery. Without surgery, conservative treatment may lead to an increase in hematoma and progressive surrounding edema, which could compress the brainstem, cause brain herniation, and lead to respiratory and circulatory failure, posing a life-threatening risk. Hemorrhages in the brainstem and cerebellum are even more dangerous. The brainstem is the center of vital functions, including the centers for breathing and heart rate. Typically, a bleeding volume exceeding 5 milliliters in the brainstem can lead to patient death. Since the cerebellum is close to the brainstem and might compress it, a bleeding volume exceeding 10 milliliters in the cerebellum often warrants consideration for surgery.
What to do about migraines?
Migraine is a very common neurological disorder, generally related to dysfunction in vascular contraction and expansion, abnormal neurotransmitter secretion in the brain, and trigeminal nerve dysfunction. If a patient experiences recurring headaches, they can visit the department of neurology for a comprehensive examination using cranial CT or MRI. Once intracranial organic diseases are ruled out, a diagnosis of migraine can generally be confirmed, and related treatment can be administered. If a patient experiences frequent headaches, but they are not severe, long-term oral administration of traditional Chinese medicine can be prescribed, typically for a course of at least 28 days. If the headaches are severe but occur less frequently, temporary oral administration of pain relief medication may be recommended, commonly using non-steroidal anti-inflammatory drugs.
How is encephalitis diagnosed?
The diagnosis of encephalitis relies on the following aspects. First, it is based on clinical manifestations. If the patient clearly exhibits symptoms such as headache, fever, nausea, vomiting, and signs of increased intracranial pressure, and physical examination shows positive signs of meningeal irritation, then there is a high suspicion of encephalitis. Second, various auxiliary tests can be conducted. Initially non-invasive tests such as electroencephalograms (EEG) and magnetic resonance imaging (MRI) of the skull can be completed. If the MRI reveals significant abnormalities, such as abnormal signals in the frontal and temporal lobes including the hippocampus, then viral encephalitis should be highly suspected. If the EEG shows moderate abnormalities or increased slow waves, it also indicates damage to the cerebral cortex, serving as an indirect indicator of encephalitis. Third, a lumbar puncture can be performed to ascertain any abnormalities in the cerebrospinal fluid (CSF) routine and biochemical tests. If the cell count is elevated beyond ten times the normal value, an inflammatory infection is considered. There is often a minor to moderate increase in protein. The levels of glucose and chloride may decrease in bacterial and tuberculous encephalitis, while they are generally normal in viral encephalitis.
What are the symptoms of cerebral hemorrhage?
Patients with cerebral hemorrhage typically experience sudden headaches during physical activity or emotional excitation as their initial symptom, which may be accompanied by nausea and vomiting. In severe cases, vomiting can be projectile, consisting of stomach contents. If the patient has stress ulcers leading to bleeding and erosion of the gastric mucosa, they may vomit a coffee-ground-like liquid, which is a mixture of gastric juices and blood. Additionally, patients may also exhibit disturbances in consciousness, such as drowsiness, stupor, or even coma. If the patient is conscious, one may observe hemiplegia or paralysis, sometimes accompanied by speech impairments or psychiatric symptoms. Some patients may also experience epileptic seizures.
Is the blood count high in encephalitis?
Not all cases of encephalitis show an increase in blood counts. Elevated blood counts in encephalitis generally occur in bacterial infections, such as the most common pyogenic meningitis. This can cause a significant increase in blood counts, predominantly with neutrophils. Tuberculous meningitis can also show elevated blood counts, but not as prominently as pyogenic meningitis. In cases of viral infection, such as the common herpes simplex virus infection, patients might experience a decrease in blood counts. This is characterized by a reduction in the total number of white blood cells, a lower proportion of neutrophils, and a possible increase in lymphocyte proportion. If the patient has a concurrent lung infection or other bacterial infections at different sites, there might be an increase in blood counts, which can mask the blood abnormalities originally caused by the viral infection.