Ms. Greenaway-Amyotrophic Lateral Sclerosis-(Romania)-Posted on June 13th, 2017

Name: Ms. Greenaway
Sex: Female
Nationality: Romanian
Age: 61Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis(ALS) 2. Hypertension 2 degree
Date of Admission: Feb. 16th, 2017
Treatment hospital/period: Wu Medical Center/13 days

Before treatment:
The patient was unable to speak clearly without any obvious reason. She spoke slowly, swallowed food with difficulty and when drinking she sometimes choked.  There was fasciculation in her left arm. Her disease progressed. There was muscle atrophy in her left arm and  her speaking became even worse so she went to hospital and was diagnosed with ALS. At present, the muscle power of her left arm is weak, the right arm and legs  also show weakness. Her exercise tolerance is bad, she needs help with eating and putting on clothes,. She is able to sit up, stand up and walk by herself. She is taking Riluzole, but without any positive effect. She wants a better life so she came to our hospital.
Her spirit, diet, sleep, bladder and bowel actions are normal. She has lost around 2 kg in weight.

Admission PE:
Bp: 146/86mmHg, Hr: 86/min, breathing rate: 19/min, body temperature: 36.6 degrees. Nutrition status is normal with normal physical development. There is no injury or bleeding spots of her skin and mucosa, no blausucht, no throat congestion, and her tonsils do not have swelling. Chest develop is normal, the respiratory sounds in both upper lungs area were clear, breathing sound of lower lungs is weak, there was no dry or moist rales. Sat is around 90-95%. The heart beat is powerful with regular cardiac rhythm and with no obvious murmur in the valves. The abdomen was soft with no masses or tenderness. The liver and spleen were normal, shifting dullness test is negative. The spinal column is normal and there was no edema in her legs.

Nervous System Examination:
Patient was alert and mental status was good. She had dysarthria and her speech was not very clear. The memory, orientation and calculation ability were normal . Both pupils were equal in size and round, diameter of 3mm, react well to light and the eyeballs can move freely. There is no nystagmus. Bilateral forehead wrinkle and nasolabial fold are symmetrical, she can put her tongue out to her lip but there is tongue muscle atrophy. Showing the teeth is normal. The tongue muscle movement ability is very limited. Her tongue cannot touch the cheek powerfully and she can not bulge her cheek in a normal manner. The chewing ability is normal but the bilateral soft palate cannot lift powerfully, Pharyngeal reflex is weak. She can close her eyes as normal. There was obvious muscle atrophy of the bilateral shoulder area, intercostal muscles, left arm and left side thenar muscles. Her neck is soft, she can turn her head and shrug as normal. Muscle power of left arm:adduction muscles of upper arm is 4 degrees; abductor muscle power is 3+ degrees; forearm flexor muscle power is 3 degrees, extensor muscle power is 2+ degrees, grip force of left hand is 3 degrees.
Muscle power of right arm: adduction abductor muscles of upper arm is 4 degrees; forearm flexor muscle power is 3+ degrees, extensor muscle power is 3 degrees, grip force of left hand is 4 degrees. Muscle power of legs is 4 degrees. The muscle tone of all 4 limbs is normal, the ankle clonus is negative. The bilateral bicipital tendon reflex, radial periosteal reflex, patellar tendon reflex and Achilles tendon reflex are normal. The palm-jerk reflex of both sides are positive, the Hoffmann sign of both side are negative, bilateral Babinski signs are negative, finger to nose test, the fast alternate movement are basically normal. The finger opposite movement of the left side is clumsy. She can not perform that test with the small fingers but right side is normal. Heel-knee-tibia test is basically normal. Meningeal irritation sign is negative.

Treatment:
After the admission, she was diagnosed with Amyotrophic lateral sclerosis. She received 3 neural stem cell injections and 3 mesenchymal stem cell injections to repair her damaged motor nerves, replace dead nerves with new injected stem cells, nourish nerves, regulate her immune system and improve blood circulation. This was done with rehabilitation training.     

Post-treatment:
After 13 days of treatment, her breathing function is better, the oxyhemoglobin saturation increased to 95-99%. Her exercise tolerance is better. Swallowing function is better than before, choking has reduced and she is able to eat faster The muscle power of all four limbs is level 4, her movement flexibility is better, the grip of both hands is better, she has less fasciculation and she is able to walk longer distances.

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