Aivar Vahar - Amyotrophic lateral sclerosis (Estonia) Posted on September 14, 2012
Name: Aivar Vahar 
Sex: Male
Country: Estonia
Age: 45
Diagnoses: 1. ALS (Amyotrophic lateral sclerosis) 2. HLP (hyperlipidaemia)
Admission Date: 2012-07-23
Days Admitted to Hospital: 28
Before treatment:
The patient suffered from numbness and weakness of right lower limb. Then progressed with weakness of right upper limb and left lower limb. He had poor balance ability and fell down easily. He went to the local hospital and the diagnosis was not clear. The disease was aggravated in October 2011. He received MRI and EEG of head and blood examination. Then he was diagnosed with ALS (amyotrophic lateral sclerosis). He took Riluzole for therapy. About several months ago, the patient suffered from blurring and cough with swallow. At the admission, the patient had difficulty with raise upper limbs. He had poor fine motor ability movement. He couldn't stand or walk by himself. He also had blurring and coughing while swallowing.
Examination of nervous system:
Alert, mental status was normal, patient could not speak fluently. The examination of calculation abilities, memory, and orientation capabilities were all normal. The bilateral pupils were equal and round, diameter was 2mm, react well to light. The eyeballs could move freely at any orientation with mild horizontal nystagmus, the left eyeball could not focus as normal. Forehead wrinkle was symmetrical and equal. Nasolabial fold of both sides were equal in depth. The tongue was centered in the oral cavity. The teeth were shown without deflection. The soft palate muscle strength was weak. He had difficulties with swallowing and coughed while drinking. He had weak muscle to shrug shoulders. The muscle strength of both upper limbs was level 4. The hold power of both hands was level 3. There was obvious atrophy in bilateral deltoid muscle, biceps brachii, triceps brachii, shoulder girdle and both hands. The muscle strength of both lower limbs was level 3. He couldn't get up, stand or walk by himself. The muscle tone of both upper limbs was close to normal. The muscle tone of both lower limbs was higher than normal. The tendon reflex of four limbs was active. The abdominal reflex was not elicited. Bilateral palm jaw reflex was positive. The Hoffmann sign was positive. The Rossilimo sign was positive. The bilateral deep sensation and shallow sensation through coarse measurement was normal. He could do the finger-to-nose test and the rapid rotation test, but in an unstable manner. He could point thumb with other fingers, but in an unstable manner. He had difficulty with both legs during the heel-knee-shin test. There were no signs of meningeal irritation. 15 days before the admission, the patient started the use of a ventilator, 15 minutes each day. ST pattern, IPAP 8cmH2O, EPAP 3.2cmH2O. The patient could tolerate it.
Treatment:
After admission, the patient was given a complete examination. He was diagnosed with 1. ALS (amyotrophic lateral sclerosis) 2. HLP (hyperlipidaemia). He received treatment 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 improve the body's immune system and antioxidant. This was combined with physical rehabilitation therapy.
Post-treatment:
The patient's condition is better than before. The Ventilator's parameter adjust to IPAP 11cmH2O, EPAP 6cmH2O, 4-6 hours each day. The patient has good tolerance. At present, the cough occurrence while swallowing is reduced. The muscle strength of the muscles of the back has improved. He can turn over more quickly. The hold power of both hands reached level 4. The muscle strength of both lower limbs reached level 4+. He can stand without support. With the assistance of a walking aid, he can walk. He can raise his legs and wear slippers more flexible.
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