Fahad - Demyelinating polyneuropathy (Saudi Arabia) Posted on January 14, 2013

Name: FAHAD MOKHTAR SALAM MOHAMMED                 
Sex: Male
Country: Saudi Arabia
Age: 27
Diagnoses: 1.Chronic inflammatory demyelinating polyneuropathy
2. Hyperlipidemia 3. Fatty liver (moderate)
Admission Date: December 15, 2012
Days Admitted to Hospital: 28 days

Before treatment:
Fahad had difficulty with walking up and down stairs starting 14 years ago without obvious incentive and he couldn't do the actions by himself. The disease progressed gradually. He went to a local hospital and was diagnosed with Chronic inflammatory demyelinating polyneuropathy. He took three oral medications: Prednisone 40mg qod, Vitamin D400U qd and calcium carbonate 2 tablets for 6 years, but still his condition showed no improvement. He also suffered from weakness in both of his upper limbs. He had difficulty with sitting up from clinostatism; meaning to bend or lie down. He had difficulty standing up from the squatting position or sitting position. He was unable to stand or walk by himself. With the support of others, the patient could barely manage to walk. He had an unstable gait, poor endurance, exhausted easily and had difficulty with getting up the stairs.

Nervous System Examination:
Fahad Mokhtar Salam Mohammed was alert and he was in good spirits. His speech was clear. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and round, the diameter was about 3.0mms. Both pupils had sensitive responses to light stimulus and the eyeballs could move freely. The forehead wrinkle pattern was symmetrical. The eye closing ability was strong. The tongue was centered in the oral cavity. The muscle strength of raise soft palate was strong. The neck was soft without resistance. There was no obvious atrophy in the whole body. The muscle strength of swivel was strong. The muscle strength to shrug shoulders was level 5-. Left side: The adduction muscle strength and abduction muscle strength of left upper limb was level 4+. The muscle strength of bend elbow joint was level 4+. The muscle strength of push forward of forearm was level 5. The muscle strength of digital interossei was level 3. The muscle strength of bend and stretch fingers was level 5-. Right side: The adduction muscle strength and abduction muscle strength of right upper limb was level 4+. The flexion muscle strength of elbow joint was level 4. The push forward strength of forearm was level 4. The muscle strength of digital interosseous was level 3. The muscle strength of bend and stretch fingers was level 5-. The muscle strength of straight leg raise of both lower limbs was level 2+. The muscle strength to stretch the knees was level 3. He couldn't bend his knees or hips. The muscle strength of adduction and abduction was level 3-. Both feet were unable to finish the dorsal flexure and plantar flexion. Both lower limbs were asymmetrical. The diameter of the right calf was larger than the left calf. It was ice-cold from both calves to both feet. Both lower limbs were outward turning. He needed some assistance to turn over. He had difficulty with sitting up from lying position. He had difficulty with standing up from squatting/sitting position. He had difficulty with standing and walking independently. The muscle tone of the four limbs was almost normal. The tendon reflex of the four limbs and the abdominal reflexes were not present. Bilateral palm jaw reflex was negative. Bilateral Hoffman sign and Bilateral Babinski sign were negative. The deep and shallow sensation of the four limbs had decreased. The sensation in both feet, at the far end, were more severe. He was able to finish the finger to nose test, the digital opposition test and the rapid rotation test. He was unable to finish the heel-knee-shin test. He had poor balance ability in upright position. The meningeal irritation was negative. Laboratory test: blood lipids were elevated, liver function (aminopherase) was increased. The ultrasound showed he had fatty liver.

Treatment:
Fahad received all of the relevant examinations. The patient received treatment for nerve regeneration, to protect liver function, to reduce kinase, to improve the blood circulation in order to increase the blood supply to the damaged nerves, and to nourish the neurons. He also received treatment to promote neural repair. This was combined with physical rehabilitation training.

Post-treatment:
At present, Fahad's condition has improved. He now has stronger muscles to turn his head. The muscle strength of shrugging his shoulders is now level 5. The muscle strength of interosseous has increased to level 4. The muscle strength of other upper limbs has been restored to level 5. He can bend his knees, although the left side is more obvious than the right side. After bending his knees passively, he can keep the flexion position; then he can straighten his lower limbs out slowly. The muscle strength to turn over has increased. He can stand up from a sitting position more easily. With some assistance, he can walk a longer distance. His endurance has increased. The muscle strength of adduction and abduction of both lower limbs is now at level 3. The temperature from both calves to both feet has been restored to normal. The deep sensation of the left lower limb is better than before.

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