Sofia Granja-Periventricular Leukomalacia-(Uruguay)

Name: Sofia Granja
Sex: Female
Nationality: Uruguay
Age: 6Y
Diagnosis: Periventricular Leukomalacia
Discharge Date: 2019/08/08

Before treatment:
The patient underwent a cesarean section at 32 weeks, weighed 1kg at birth, did not breathe autonomously and was diagnosed with respiratory distress syndrome, done with 48 hours of ventilator treatment. She was discharged from hospital after treatment. She has growth retardation and was diagnosed as having "periventricular leukomalacia" at the local hospital. The child could walk at the age of 2 and at the age of two and a half she spoke the first word.  Now her pronunciation is OK but so far the language is limited to a few words and she cannot speak sentences. She is able to understand what others are saying and she receives language rehabilitation training every week. Both eyes can chase light, the cognition of color is uncertain. She has hearing. She can drink water and eat independently, she can't go to the toilet independently, she can't walk well, she can't draw or count. The strength of her trunk is OK, she can roll over, sit up, keep sitting, stand and walk, and she can move her limbs. Both arms can do fine movement but the strength is not good.

Admission PE:
Bp: 109/61mmHg, Hr: 110/min, breathing rate: 20/min, body temperature: 36.4, height: 115cm, weight: 17kg. The patient has retarded development, good nutrition, no yellow stains or bleeding spots of the skin and mucosa, normal color of her lips, no congestion of throat and no swelling of the tonsils. She has a slightly dissymmetrical chest, clear respiratory sounds of both lungs, no dry or moist rales heard, strong heartbeat, regular heart rate and no obvious murmur heard. She has a flat and soft abdomen, no masses, no tenderness, no rebound tenderness, normal liver and spleen by palpation.

Nervous System Examination:
Patient was alert, speech was restricted to a couple of words with no complete sentences, she has basic intelligence and is able to understand and follow instructions. She could not complete the memory, calculation and orientation tests. Both pupils are round with same diameter being 3mm, are sensitive to light, can follow moving objects with coordinated movement. She could not complete the other cranial nerve function examination. Normal chewing and swallowing, no choking when drinking. She could not complete the  muscle power examination, she can lift her head and turn her body, with unremarkable trunk strength. She can turn over, sit up, sit, stand up and walk by herself. She displayed normal limbs movement. Both hands can do fine movement but the power is weak. There is abnormal leg movement with over-flexion of the left ankle joint. There is normal muscle tone of the 4 limbs and normal tendon reflex of the arms, reduced knee tendon reflex bilaterally, no heel tendon reflex, normal abdominal reflex, negative sucking reflex bilaterally and negative Babinski sign bilaterally. She could not complete the sensation and coordination test. There was a negative meningeal irritation sign.

Treatment:
After the admission she received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair her damaged nerves, replace dead nerves, nourish nerves (ganglioside, nerve growth factors), improve body environment, regulate her immune system and improve blood circulation. This was combined with rehabilitation training.   

Post-treatment:
After 14 days treatment her condition got better than before. Her speech function got better, she begun to try three words together, her motor function got better with more strength of the arms, she could grasp objects, walking gait got better, she raised her legs higher and moved the joints easier. She now walked with the whole foot on the ground and can now climb up and down stairs.

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