Fahad - Amyotrophic lateral sclerosis(Saudi Arabia) Posted on January 7, 2013

Name: Fahad Al Mutairi                    
Sex: Male
Country: Saudi Arabia
Age: 41
Diagnoses: ALS (Amyotrophic lateral sclerosis), Nodal tachycardia, Hyperlipidemia
Admission Date: November 23, 2012
Days Admitted to Hospital: 28 days

Medical History:
Fahad Al Mutairi was presented with progressive myasthenia in both lower limbs for the past 2 years without obvious incentive. He falls down because of weakness in both lower limbs when attempting to stand up from a sitting position. He went to a local hospital and received physical examination, MRI of the head and an EMG examination. He was diagnosed with amyotrophic lateral sclerosis. He received drug therapy, but the disease became aggravated gradually. The weakness in both lower limbs was aggravated. Both lower limbs had muscle atrophy. One year later, the patient's upper limbs began to show muscle weakness and muscle atrophy as well. He lost the ability to take care of himself. The patient lost all walking ability 9 months ago. After that he didn't take any medication. Five months ago, the disease progressed even further. The patient began suffering from speech disorder, swallowing difficulty, dining time extension, insomnia, and only slept four hours every day.

Admission PE:
Hr: 110/min, Br: 23/min. The thoracic expansion was small. The respiratory sounds in the respiratory sounds in both lower lungs were weak.

Nervous System Examination:
Fahad Al Mutairi was alert and he had poor spirits. His speech wasn't clear and the intonation was low. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and their diameter was 2.5mms. Both eyeballs could move flexibly and the pupils reacted normally to light stimulus. The converging ability of both eyes was poor. The forehead wrinkle pattern was symmetrical. The eye closing ability was strong. The bilateral nasolabial sulcus was equal in depth. The tongue was centered in the oral cavity. There was obvious atrophy in tongue. The tongue muscle had poor movement and had fibrillation. The teeth were shown without deflection. The soft palate muscle strength was weak. The pharyngeal reflex was responsive. The chew and swallow ability was poor. The muscle strength of the cheeks was weak. The cheeks couldn't be expanded normally and the right side had obvious air leakage. There was multiple severe muscle atrophy in the whole body. The muscle strength of both upper limbs proximal was level 1. The muscle strength of left wrist joint was level 2-, the muscle strength of right wrist joint was level 2. The hold power of left hand was level 2-, the hold power of right hand was level 2. Both thumbs presented with flexion position. The movement of all the fingers was not flexible. The muscle strength of both lower limbs was level 0-1. The muscle tone of both upper limbs was slightly lower than normal; the muscle tone of both lower limbs was slightly higher than normal. The tendon reflex of both upper limbs was not present. The tendon reflex of both lower limbs was responsive. The bilateral abdominal reflexes were not present. Bilateral sucking reflex, jaw reflex and palm jaw reflex were positive. Bilateral Hoffmann sign, Rossilimo sign and Babinski sign were negative. Bilateral deep sensation, shallow sensation and composite cortex sensation were normal through loose measure. He was unable to finish the finger-to-nose test, the rapid rotation test, the digit opposition test or the heel-knee-shin test. There were no signs of meningeal irritation.

Treatment:
The patient was given treatment on November 23, 2012. 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 strengthen nutrition, control heart rate, nerve regeneration, neural repair, and to regulate blood fat. He wears a non-invasive ventilator for breathing. This was combined with physical rehabilitation training.

Post-treatment:
At present, Fahad Al Mutairi's condition has improved. He has good spirits and he has a good appetite. He has gained some weight. The sleep is regular and he now sleeps for more than 6-8 hours a night. Br: 20/min. The thoracic expansion has enlarged. The respiratory functions have improved. The respiratory sounds in both lungs are now clear. The speech and pronunciation is clearer than before and the intonation is better than before. The muscle strength of the whole body is better than before. The movement of the tongue is better, and he can now bulge his cheeks out. The chew and swallow ability is almost normal. Both upper limbs can do adduction and the translational motion. The muscle strength of stretch and bend of elbow joint has increased obviously. The muscle strength of both lower limbs has reached level 2. Both knee joints can lift from the bed surface.