Emem Etim - Retinitis pigmentosa (Nigeria) Posted on January 2, 2014

Name: Emem Etim

Gender:Female

Age:37 years old

Country: Nigeria

Diagnoses: Retinitis pigmentosa, Mild anaemia, Pelvic lump, Hypertension level 1, Hyperlipidaemia

Admission Date: 2013-11-18

Days Admitted to the Hospital:28

Before treatment:
The patient suffered from blurred vision of both eyes during the examination 27 years ago and with no obvious incentives. She went to America for therapy and was diagnosed with retinitis pigmentosa. She didn't receive special treatment. The disease progress gradually and only presented lower field. She also had uncompleted vision. About 14 years ago, the patient had improvement in both visual fields. The upper vision appeared. Before treatment, the patient's vision was poor and only could see big object. She had difficulty to distinguish colors. Right eye was better than left eye. She had difficulty with activities of daily living. From the onset of disease, the weight had no obvious change. The diet and sleep were almost normal. The defecation and urine routine were normal. The same disease does not run in her family.

Admission PE:
Bp: 143/93mmHg; Hr: 85/min, Br: 19/min. The patient had normal body type and development. The skin and mucosa were normal. The respiration in both lungs was clear, with no moist rale. The heart sounds were strong, the cardiac rhythm was regular, and there was no obvious murmur in the valves. The abdomen was enlarged, with mass in pelvic cavity. The mass was not painful when we pressed it. The liver and spleen were found to be normal through palpation. There was no edema in both lower limbs.

Nervous System Examination:
Emem Etim was alert and her speech was clear. The memory, orientation and calculation abilities were almost normal. The diameter of both pupils was 3.0mms. Both pupils had sensitive responses to consensual reflex and direct light reflex. The color vision was not good. Vision examination: with standard visual acuity chart, the patient's right eye vision was 0.06 (blur) from 3 meters distance. The left eye had blurred vision from 1 meter distance. Both eyeballs could move freely to each side. There was visual field defect. There was no obvious nystagmus in both eyes. Fundus examination: right eye: there was black osteoid sediment in right eye. The arteriovenous ratio was 2:3. The color of fundus was light yellow. There was stripe softness around the vein. This was accompanied with dotted exudate. Left eye: there were osteoid black sediments in left eye and the ambitus had more sediment. The arteriovenous ratio was 1:3. The color of fundus was light yellow. The forehead wrinkle pattern was symmetrical. The nasolabial sulcus was equal in depth. The teeth were symmetrical. The tongue was at the center of oral cavity. The neck could move freely. The muscle tone of four limbs was almost normal. The muscle strength of four limbs was about at level 5. The abdominal reflexes were not elicited. The tendon reflex of four limbs was normal. The sucking reflex and palm jaw reflex were negative. Bilateral Hoffmann sign was negative. The Rossolimo sign of both upper limbs was negative. The pathological reflex of both lower limbs was negative. The deep sensation and shallow sensation existed. The examination of coordinate movement was normal.

Treatment:
We gave Emem Etim a complete examination. The blood pressure measured three times after admission, all the results were greater than 140/90mmHg. She was diagnosed with Hypertension level 1. With the laboratory examination, she was also diagnosed with anaemia and hyperlipidaemia. The patient received nerve regeneration treatment and stem cell activating treatment. She received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves and nourish the neurons. She was also given treatment to reduce blood pressure, adjust anemia and blood lipid. This was accompanied with muscle massage on the face and around the eyes.

Post-treatment:
The blood pressure was under control. Binocular vision has improved after treatment. With standard visual acuity chart, the patient's vision is 0.25 from 1.3 meters; vision was 0.4 - 0.8 from 20cm. From loose measure: the right vision is 60 degrees, left side vision is 45 degrees, upside vision is 45 degrees, downside vision 60 degrees. She has better ability to distinguish between colors now. Under the examination of ophthalmoscope: The arteriovenous ratio is 2:3, this is almost normal. The color of retina is better than before. The color changed from light yellow to orange. The macula lutea and optic nerve head are clear and visible. The hyperpigmentation in periphery has reduced.

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