Moayed - Sequelae of brain injury (Saudi Arabia) Posted on April 9, 2013

Name: Moayed Abdullah Al-oufi              
Sex: Male
Country: Saudi Arabia
Age: 15
Diagnoses: 1.Sequelae of brain injury 2. Iron deficiency anemia
Admission Date: 2013-03-04
Days Admitted to Hospital: 28 days

Identifying Information:
Moayed Abdullah Al-oufi was injured in a car accident 8 years ago and went into a coma. He was sent to the local hospital and received head CT and hematology laboratory. Then he was diagnosed with cerebral hemorrhage. He received trachea cannula, gastrostomy and medication for treatment. 5 moths later, the patient came round gradually. But his cognitive function was obviously slowed down. He didn't recognize his family members. He couldn't speak. He received cognition rehabilitation, speech rehabilitation and sports rehabilitation. The patient's cognitive function improved and the motor function had some improvement. The patient could walk independently, but the gait had obvious abnormalities, a limp. He couldn't walk up and down stairs. Both hands couldn't hold a cup for drinking water. He had difficulty with grasping the cup. There was obvious intention tremors. This was accompanied with the shaking of the whole body. He also had a speech disorder and slobbering.

Nervous System Examination:
Moayed Abdullah Al-oufi was alert. His responses were delayed. He had unclear speech. The memory and orientation ability were normal. The calculation abilities were slowed down. Both eyeballs could move freely and flexibly and the pupils were sensitive to light stimulus. There was no diplopia. The forehead wrinkle pattern was symmetrical. The tongue was shifted slightly to the right side. The chew muscle was weak. The soft palate could be raised strongly. The swallow ability was poor and coughing while drinking occurred occasionally. The neck could be turned flexibly and the left shoulder had strong shrugging ability. But the right shoulder had weak shrugging ability. The adduction and abduction of both upper limbs was level 5-. The hold power of the left hand was level 3. The hold power of the right hand was level 4. The muscle strength of the lower limbs' near-end was level 5-. The muscle strength of the lower limbs' far-end was level 4. The left upper limb had a slight static tremor. There were tremors when both upper limbs did exercises. The tremor was a volitional tremor. And the left side was more severe. The fine motor skills were limited. Both sides were unable to finish holding an object, writing or eating action. The muscle tone of the four limbs was almost normal. The right side Babinski sign was positive. The deep sensation and shallow sensation of both sides were almost normal. The right side was able to finish the digital opposition test, but in a clumsy manner. The left hand only could point the thumb with little finger and the third finger. Both side did the rapid rotation test and the finger-to-nose test, but in a clumsy manner. The left side completed the heel-knee-shin test in a stable manner. The right side completed the rapid rotation test in an unstable manner. He had some difficulty with the Romberg's sign test. There were no signs of meningeal irritation. The blood routine at the admission: HGB 108g/L.

Treatment:
We initially gave Moayed Abdullah Al-oufi a complete examination, and he was diagnosed with sequelae of brain injury. He was then given treatment in order to expand the blood vessels and nourish the neurons. He also received treatment for nerve repair and nerve regeneration. This was combined with physical rehabilitation training.

Post-treatment:
After treatment, Moayed's anemia has disappeared. His speech is clearer than before. The hold power of both hands has increased and reached level 4. Both upper limbs' coordination movement has seen significant improvement. His right hand can hold a cup for drinking water and eating. He does the finger-to-nose test more stably. He does the digital opposition test more flexibly. Both side can point the thumb with others fingers. The range and frequency of the intentional tremor is alleviated. The fine motor skill of both hands has improved. He can pick up a small wood nail and the right hand does the action better. The walking ability has improved and the gait is better. He can go up and down stairs.