Chan Choi Yin-Neuromyelitis Optica-(Singapore)

Name: Chan Choi Yin
Sex: Female
Nationality: Singaporean
Age: 44Y
Diagnosis: neuromyelitis optica

Before treatment:
In June 2014 the patient was unable to see objects clearly and she was also having headaches. She almost lost her left vision function and her right eye vision was also bad so she went to a local hospital and was diagnosed with neuromyelitis optica. The doctor treated her with steroid glycoside through IV and her vision function became better. Her right eye vision was still bad but her left eye vision improved 50%. From then on the patient’s eye function became worse more frequently and each time she was treated with steroid glycoside through IV or plasmapheresis. In October 2016 her vision function became worse again and there was no improvement after treatment. Her left eye only preserved light sense, her right eye only preserved 25% vision function. She stopped using steroid glycoside 1 month ago and began to take oral immunodepressant (mycophenolate mofetil) 500mg twice a day. She wants a better life so she came to our hospital.
Her spirit and weight are normal. She sleeps and eats well. Both her urination and defecation functions are good.

Admission PE:
Bp: 125/85mmHg, Hr: 87/min, breathing rate 18/min. Nutrition status is normal and she has normal physical development. There is no injury or bleeding spots of her skin and mucosa, no blausucht. Chest develop is normal, the respiratory sounds in both lungs were clear and there was no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and with no obvious murmur in the valves. The abdomen was soft with no masses or tenderness. Her liver and spleen were normal by touch examination.

Nervous System Examination:
Patient was alert and her spirit was good and her speech is very clear. The memory, orientation and calculation ability were all normal. Both pupils were equal in size and round, diameter of 4 mm, react well to light, eyeballs can move freely. The left side eyesight is poor. She can distinguish the fingers at 10 cm distance, the color distinguishing ability is poor also and the right eye color vision was damaged. Her right side eyesight is 0.8 with standard 3m visual chart. There is pallor papillae of the left eye, optic atrophy, AV ratio 1:3. Bilateral forehead wrinkle is symmetrical, showing teeth is normal, tongue is in the middle position and the neck can move freely. Muscle tone of the 4 limbs are normal and muscle power of the 4 limbs are 5 degrees. Abdominal reflex can be induced by examination, bilateralbicipital tendon reflex, radial periosteal reflex, Patellar tendon reflex and Achilles tendon reflex are hyperactive. Sucking reflex and palm-jaw reflex is negative, bilateral Hoffmann signs are negative, Rossolimo sign of the arms are positive. Pathological reflex of the legs are negative. Sensory examination is normal, coordinate movement is normal, the Meningeal irritation sign is negative.

After the admission, she received related examinations and was diagnosed with neuromyelitis optica. She received 3 times nerve regeneration treatment to repair her damaged nerves, replace dead nerves, nourish nerves, regulate her immune system and improve blood circulation. This was done with rehabilitation training.     

After 14 days’ treatment, her color distinguishing ability is much better. The eyesight has improved, she can now distinguish the fingers at 30 cm distance with her left eye. Her right eyesight is 1.0 with the standard 3m visual chart.




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