Rabiy Gembre - ALS (Kuwait) Posted on May 16, 2014

Name:Rabiy Gembre                   
Sex: Male
Country: Kuwait
Age:68 years
Diagnosis: Amyotrophic Lateral Sclerosis
Date:May 04, 2014
Days Admitted to Hospital: 25 days

Before treatment:
The patient suffered from dysphoria, dysarthria, breathing difficulty and weakness of his left limbs 4 years ago. He was sent to a hospital and he received head imaging examination. The examination showed right middle cerebral artery occlusion and it led to large area cerebral infarction of right side. The patient received tracheal cannula and mechanical ventilation and so on emergency treatment. 10 days later, the patient had stable vital signs. 14 days later, he was transferred to general ward. He received 3 times rehabilitation every week after discharge from hospital. Before the treatment, the patient presented with motor dysfunction and sensory disorders of the left limbs.  He also had difficulty with standing or walking. He was diagnosed with amyotrophic lateral sclerosis.

From the onset of disease, the patient's spirit was weak. The diet and sleep was good. The weight had no obvious change. The patient's has four brothers and all of them suffered from diabetes. There was no history of stroke.

Admission PE:
Bp: 135/80mmHg; Hr: 64/min. The nutrition was normal. He had hemiplegic gait. The respiratory sounds in both lungs were clear, with no dry or moist rales. The cardiac rhythm was regular. The abdomen was soft, with no pressing pain. The liver and spleen were not palpable. There was no edema in both lower limbs.

Nervous System Examination:
Rabiy Gembre was alert, and his spirit was ok. He had sensitive response. The examination of memory, calculation and orientation were almost normal. He had strong muscles to close the eyes. Both pupils were equally rounded; the diameter was about 3.0mm. Both eyeballs were sensitive to light stimulus. Both eyes could move freely. There was no horizontal nystagmus. The pain sensation of left face was slightly down. The tongue was deflected to the left side. The corner of mouth was shifted to right side. The uvula was almost in the center. The muscle strength to turn head was strong and symmetrical. The left shoulder was sinking. The range of motion of the left shoulder was limited.  The muscle strength to shrug left shoulder was weak.  The muscle tone of the left limbs was higher than normal. The muscle strength of the left upper limb was at level 1. The grasp power of the left hand was at level 1. Left hands couldn't stretch and bend fingers completely. The muscle strength of the left lower limb was at level 3. Left foot suffered from slight introversion. His feet bend backward and downward with great efforts. Left side abdominal reflexes disappeared. Left side tendon reflex was active. Bilateral palm jaw reflex was positive. Left side Babinski sign was positive. Left side suffered from hemihypalgesia and warm sensation was slow down. His left side was unable to finish the finger-to-nose test, the rapid rotation test or digital opposition test. Left side did the heel-knee-shin test in an unstable manner.  There were no signs of meningeal irritation. The laboratory test showed the fasting blood-glucose level was normal. The 2-hour post-meal blood glucose level 10-11mmol/L.

Treatment:
Rabiy Gembre received all of the relevant examinations and he was diagnosed with sequelae of cerebral infarction and type 2 diabetes. He received treatment for nerve regeneration and to activate stem cells in the body. 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 regulate blood sugar level. This was combined with physical rehabilitation training.

Post treatment:
The patient's mood has improved. He looks younger than before. The weakness of his left limbs is not severe and the muscle strength of left limbs have increased obviously. The ptosis of left shoulder is alleviated. The range of motion of the left shoulder has increased. The ability to control the left shoulder has improved. The muscle strength of the left upper limb's near-end is at level 2+, the far-end of left upper limb is at level 3-. The adduction of left upper limb has obvious improvement. The left hand has obvious action to bend fingers. The grasp power of left hand is at level 3-. The muscle strength of the left lower limb's near-end is at level 4+. The muscle strength of the left lower limb's far-end is at level 4-. Left foot can bend backward and downward in a large range, the range increased obviously. The muscle strength to straight and raise leg has increased. The left side pain sensation and warm sensation has obviously been restored. After treatment, the blood sugar level is almost normal, (fasting blood-glucose level is normal, the 2-hour post-meal blood glucose 5-7mmol/L).