Dr. Fang from the radiology department pointed at the image and said, "At the top of the brain, along the falx cerebri and the convex surfaces of both cerebral hemispheres, there’s a distinct linear enhancement. That layer of enhancement is very uniform and smooth, like a shell enveloping the surface of the brain."

Dr. Fang enlarged the image and looked again, "That’s right, it’s diffuse thickening and enhancement of the dura mater."

Zhaxi now felt the significance of advanced study at a top hospital, where each specialty has its experts, learning from these experts regularly broadens his perspective and naturally improves his skills.

The technician continued scanning while Dr. Fang continued observing. In the posterior cranial fossa, along the tentorium cerebelli and around the foramen magnum of the occipital bone, there was similar enhancement. The entire dura mater, from front to back, from left to right, showed complete thickening and enhancement. This is the classic presentation of hypertrophic pachymeningitis.

Zhaxi’s hand started to tremble; his diagnosis was correct. He picked up his phone and sent a message to Yang Ping, "Professor Yang, the MRI results are out. Diffuse thickening and enhancement of the dura mater, consistent with the presentation of hypertrophic pachymeningitis."

Yang Ping replied instantly, "Good! Come to my office."

Zhaxi ran to Yang Ping’s office and pushed the door open. Yang Ping was standing in front of the whiteboard, holding a marker. Seeing Zhaxi come in, he said, "Draw the MRI results." 𝗳𝚛𝗲𝕖𝕨𝕖𝗯𝚗𝚘𝕧𝕖𝗹.𝗰𝗼𝕞

Zhaxi took the pen and froze; he didn’t know how to draw.

Yang Ping did not blame him but said gently, "So there are many things you need to learn now, medical illustration, image interpretation, reading and analysis of test results, etc. Your medical history collection has improved a lot, but physical examination needs strengthening, and independent analysis of auxiliary examinations is still lacking. Any diagnosis basis for a patient is nothing more than medical history, physical examination, and auxiliary examinations. But there’s no rush for this, the training plan I gave you includes these aspects. As long as you implement each point, these issues will be resolved."

Zhaxi blushed. Yang Ping quickly took the pen from his hand and drew the patient’s head anatomy diagram on the whiteboard, "The diagnosis is clear. Now, what is the problem?"

Zhaxi thought for a moment and said, "The cause. Hypertrophic pachymeningitis can be idiopathic or secondary. Secondary causes include infection, tumors, autoimmune diseases. Further investigation is needed to find the cause."

Yang Ping nodded, "That’s right. Besides cause identification for a definite etiology, most diagnoses don’t have a clear cause. We must use diagnosis as a midpoint to deduce forward and backward, investigate forward to find the cause if possible, deduce backward to develop a treatment plan, prognosis, etc. What should we check next?"

Zhaxi opened his notebook and read out the materials he had researched, "We need to check ANCA, ACE, antinuclear antibodies, rheumatoid factor, immunoglobulins, complement, HIV, syphilis, tuberculosis infection T cell spot test, and also conduct a whole-body PET-CT to rule out potential tumors or sarcoidosis. If all these are negative, it’s idiopathic."

Looking at him, Yang Ping’s gaze contained a hint of approval, "What about the treatment plan?"

Zhaxi said, "Glucocorticoids, methylprednisolone pulse therapy, followed by oral prednisone taper. If the effect is poor, immunosuppressants like cyclophosphamide, mycophenolate mofetil, rituximab can be added."

"This is just conventional treatment; if we only settle for this, we can’t become good doctors." Yang Ping reminded.

Zhaxi realized, "I also need to review the literature to see if there are more advanced treatment methods in the world."

Yang Ping nodded in satisfaction.