lahara - Amyotrophic lateral sclerosis (Iraq) Posted on April 9, 2013

Name: lahara Saudi Ferry              
Sex: Female
Country: Iraq
Age: 46
Diagnoses: ALS (Amyotrophic lateral sclerosis), dysfunction of liver (has been cured)
Admission Date: 2013-03-02
Days Admitted to Hospital: 30 days

Before treatment:

Medical History:
lahara Saudi Ferry suffered from weakness of the right foot 2 years ago without any obvious reason. The disease progressed gradually and the right lower limb was damaged. The patient felt obvious weakness of the right lower limb when she walked. Then the left lower limb was damaged and she had difficulty with walking. She received an EMG examination in January 2012 and was diagnosed with Amyotrophic lateral sclerosis. The patient received medication for treatment, but the effect was not good. About 1 year ago, the patient also suffered from weakness of the left fingers and the movement of the fingers was not flexible. She still could deal with daily life. Then the disease progressed quickly and the weakness of the whole body worsened. She couldn't walk or eat independently. This was accompanied with a speech disorder, inflexible tongue and cough when drinking water.

Admission PE:
Bp: 128/84mmHg; Hr: 80/min, temperature 36.8 deg. Br: 18 /min. Through auscultation, it showed the respiratory sounds in both lungs were clear, with no obvious dry or moist rales. The heart rhythms were regular. The heart sounds were strong, with no obvious murmur. The abdomen was soft, with no pressing pain or rebound tenderness. The doctor didn't touch the liver or spleen under the ribs. There was concave edema below both ankle joints.

Nervous System Examination:
lahara Saudi Ferry was alert and her mental faculties were good. Her speaking voice was not low, but it was unclear. Her memory, calculation abilities and orientation were normal. Both pupils were equal in size, the diameter was 3mms. Both eyeballs could move flexibly and the pupils reacted normally to light stimulus. The forehead wrinkle pattern was symmetrical. She had strong eye closing ability. The bilateral nasolabial sulcus was equal in depth. The movement of the tongue was not flexible. The tongue was centered in the middle of the oral cavity and the teeth were shown without deflection. There was atrophy and an obvious tremor in the lingualis. There was air leakage when the cheeks were expanded. The muscles of the soft palate were strong and symmetrical. The pharyngeal reflex existed. Occasionally, there was a cough when drinking water. There was muscle atrophy in the bilateral triceps muscle of arm, interosseous of both hands and the big and small thenar muscle. The adduction muscle strength of both upper limbs was level 4-, the abduction muscle strength of both upper limbs was level 2+. The hold power of both hands was level 4-. The muscle strength of the right lower limb was level 2-. The muscle strength of the left lower limb was level 2+. The muscle tone of the four limbs was reduced slightly. The deep sensation and shallow sensation of both side was normal through loose measure. The tendon reflex of both upper limbs was active. The patellar tendon reflex of both lower limbs was active. The Achilles tendon reflex of both lower limbs was reduced. The abdominal reflexes were not elicited. Bilateral palm jaw reflex and Hoffmann sign was positive. Bilateral Babinski sign was negative. She did the rapid rotation test and the digital test in a stable manner. She was unable to finish the heel-knee-shin test or Romberg test. There were no signs of meningeal irritation. The laboratory test showed dysfunction of the liver, aminotransferase increased, glutamic-pyruvic transaminase 68u/L.

Treatment:
We initially gave lahara Saudi Ferry a complete examination. The patient received treatment to nourish nerves, to improve her blood circulation in order to increase the blood supply to the damaged neurons, improve the immunity of the organism and improve the liver function. At the same time, we gave the patient non-invasive ventilator to increase oxygen supply, the breathing machine model BIPAP, IPAP8cmH20, EPAP5 cmH20. This was accompanied with rehabilitation training.

Post treatment:
At present, the patient's condition is better. The movement of the tongue was more flexible than before. The air leakage was not as severe when the cheeks were expanded. She can swallow more easily when she drinks water. The holding power of both hands has increased and reached level 4+ or 5-. The right lower limb can lift off the bed surface slightly and the muscle strength of the right lower limb reached level 3-. The left lower limb can provide some resistance after lifting and the muscle strength reached level 3+. The involuntary tremor of the muscles when she stands has been reduced more than before. And the patient can stand a longer time. The family member said it requires less strength to assist the patient to stand up and the patient's endurance has increased more than before. The test of the liver function showed the liver function is normal. Glutamic-pyruvic transaminase 37u/L.