The man had a headache for 14 days and died after 3 days of medical treatment. The doctor asked for an autopsy. Family members: he is engaged tomorrow

Young man, surnamed Wang, 24 years old, farmer.

It was raining heavily that day, and Xiao Wang ran home in the rain without rain gear.

The next day, Xiao Wang had a severe headache, with unbearable acupuncture-like pain in the left temporal region and back of the brain.

Thinking that he had caught a cold, Xiao Wang took ibuprofen on his own to relieve the pain. The headache was a little lighter at first, but it started again soon, and the unstoppable pain was accompanied by nausea and vomiting.

Unable to bear it any longer, Xiao Wang came to the town hospital. The doctor of the town hospital took a cervical spine film considering the reason why Xiao Wang looked at his mobile phone for a long time: considering cervical spondylosis.

Such a young cervical spondylosis may be caused by the mobile phone. The doctor prescribed some medicine to treat the headache caused by the cervical spondylosis and went home, and repeatedly asked him not to look at the mobile phone again!

Xiao Wang didn’t dare to touch his mobile phone this week, and the medicine was not delayed.

However, it backfired!

Not only did Xiao Wang’s headache not ease, but instead it became heavier. The pain like electric shocks caused him to suffer severe nausea and vomiting, which made him unbearable. At the same time, there was numbness and discomfort in the right upper limb.

There was really no other way, Xiao Wang was hospitalized and was admitted to the neurology department of the county hospital.

Postoperative doctor physical examination: blood pressure 140/66 mmHg. Clear consciousness, poor spirit, nervousness, fluent speech, and to the point.

Cranial nerve examination showed no abnormality. The neck is soft; the muscle strength of the limbs is grade 5, the muscle tension is normal, the tendon reflexes are symmetrical, the bilateral pathological signs (1), and the depth and shallowness of the limbs are symmetrical.

The point is:

Suddenly, the doctor found that animal bite marks were visible on Xiao Wang’s right wrist and left eyebrow, and the doctor was vigilant!

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Have you ever been bitten by a dog? the doctor asked.

Yes, I was bitten by a dog when I was working about 10 days ago, but at that time I went to our town hospital to clean up the wound and injected rabies vaccine, Xiao Wang said.

Well, just get vaccinated. The doctor thought it was a rabies attack and was shocked.

Brain CT results: no abnormality was found.

So what’s going on, a young man with such a severe headache accompanied by nausea and vomiting?

I’ll schedule a cranial MRI and EEG tomorrow to see if anything is found.

The results came back soon: head MRI examination showed “bilateral subcortical ischemic foci”, cervical disc herniation (slight), EEG: abnormal EEG. Blood analysis showed slightly higher lymphocytes. Liver and kidney function tests were unremarkable.

The occurrence of cerebral ischemia at such a young age is not in line with common sense. Maybe it has something to do with cervical spondylosis. The doctor is also puzzled.

Combined with Xiao Wang’s recent history of cold illness, comprehensive consideration: cervical spondylosis, viral encephalitis, neuropathic headache

He was given the treatment of promoting blood circulation and removing blood stasis, antiviral, and reducing intracranial pressure. The abnormality was: the headache was aggravated, the vomiting was more serious, and the spirit was getting worse and worse!

what happened? Seeing that Xiao Wang’s spirit was getting worse, the doctor panicked!

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Injured recently? Concussion? Xiao Wang’s family shook their heads in denial.

On the third day, Xiao Wang developed a fever with a maximum body temperature of 39°C, chest tightness, shortness of breath, and difficulty swallowing!

Physical examination: irritability, unable to cooperate completely, neck slightly stiff; wet dullness could be heard in both lower lungs; voluntary movement of limbs, high muscle tone, symmetrical tendon reflexes, no opisthotonus, bilateral pathological signs (one ).

Laboratory tests showed: liver and kidney failure, salivation and hydrophobia appeared at the same time!

Tetanus? No, there is no typical opisthonation, no history of sharps trauma.

Anti-thermal treatment, emergency consultation with infectious diseases department.

The infectious disease doctor arrived in a hurry and was shocked!

In addition to rabies has this manifestation, what else? Blood was drawn and sent to a higher-level hospital to check for anti-rabies neutralizing antibodies. At the same time strengthen antiviral and other symptomatic and supportive treatment, the infectious disease doctor almost ordered.

However, unfortunately! In the afternoon of the same day, Xiao Wang suddenly fell into a coma and was unable to breathe.

Blood pressure drops progressively, BP70/50mmhg, blood oxygen saturation drops from 90% to 60%!

Seeing that Xiao Wang was not breathing immediately, he was immediately given a tracheal intubation ventilator to assist breathing and other treatments.

But the condition was too serious, the rescue was ineffective, and the electrocardiogram was straight.

A young life just passed away.

It took 14 days from onset to death, and only 3 days after being admitted to the hospital, and a young man just disappeared. The family members were reluctant and chased after the doctor for an explanation.

Autopsy! The doctor reluctantly said that we are highly suspicious: rabies, once rabies occurs, the mortality rate is very high!

As soon as I heard the autopsy, my mother cried: Tomorrow is his engagement day, and this hospitalization did not dare to tell his in-laws….

Neither an autopsy but also a statement, the doctor is very helpless! Can only wait for tomorrow’s rabies virus neutralizing antibody results.

The hard day has finally passed, and Xiao Wang’s body is still lying there…

Result: Anti-rabies neutralizing antibody (+).

Final cause of death: Rabies!

Faced with the result, the family members were speechless and buried Xiao Wang silently.

Why is rabies difficult to detect early?

Rabies can be divided into incubation period, prodromal period, excitation period, and paralysis period.

Typical rabies patients are mainly characterized by high excitement, numbness at the wound, feeling of ants walking, restlessness or even mania, fear of water and wind, choking when drinking water, laryngeal muscle spasm, and massive salivation. Diagnosis is not difficult.

However, some patients may have the characteristic manifestations of paralysis (paralysis) or subrabies, and may also have cardiac and cerebral symptoms at first. In addition, the prodromal symptoms of patients are complex and diverse, and there is no clear history of animal bites, so it is easy to be misdiagnosed.

Why does rabies still occur after debridement and injection of rabies vaccine? !

1) Within 14 days of injection of rabies vaccine, our body cannot produce effective antibodies. At the same time, some patients fail to inject rabies virus serum in time, resulting in the failure of effective immunity.

2) Improper treatment after injury: including not being able to vaccinate as required as soon as possible, improper wound treatment, not using anti-rabies serum or human immunoglobulin in combination, and incorrect vaccine injection site.

3) Individual physical factors: the elderly, patients with chronic diseases such as liver cirrhosis, active tuberculosis, tumors, and those with weakened immune function due to the use of immunosuppressants and anti-malarial drugs, cannot activate the body’s immune system to produce sufficient rabies vaccine after vaccination. antibody.

The doctor said:
Although this case is an isolated case, this case is a wake-up call for everyone.

If you are bitten by an animal, you must not be negligent, and standardize the debridement, injection of immune globulin and standard vaccine injection as soon as possible!

Life is not easy. Once rabies has a fatality rate of nearly 100%, early formal wound treatment and rabies vaccination are the only effective measures to prevent rabies.

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