Abdulla Mohamed Hassan A Alameeri-Amyotrophic Lateral Sclerosis-(UAE)

Name: Abdulla Mohamed Hassan A Alameeri
Sex: Male
Nationality: UAE
Age: 59Y
Diagnosis: 1. ALS 2. Diabetes (type2) 3. Paroxysmal supraventricular tachycardia

Before treatment:
1 year ago, patient had no obvious incentive for right hand weakness, the disease gradually progressed, his right upper limb, right lower limb, left lower limb and left upper limb were all has involved, he went to local hospital did the electromyography and other tests, he was diagnosed with " amyotrophic lateral sclerosis". The disease continued to progress, 6 months ago, he could walk with walker, he could do daily work. 3 months ago he began to appear unclear speaking, breathing faster, further declined in motor function, he was unable to take care of himself. He had stem cells treated in Korea in 2016, no improvement after treatment. At present, patients can not stand, walk, stand up, limbs muscles are involved, respiratory function is involved, he could chew, he has occasionally cough. 2 weeks before admission he had lung infection, he was given anti-infective treatment for 5 days, for now he still has cough and sputum. This patient wants for further treatment, so he comes to our hospital.
His spirit and sleep are normal. He could only sleep in left lateral position. His diet, urination and defecation functions are normal. He lost 12Kg in one year. He has type 2 diabetes, coronary heart disease, paroxysmal supraventricular tachycardia for many years

Admission PE:
Bp: 160/90mmHg, Hr: 56/min, breathing rate 22/mim. body temperature: 36.8 degrees. His physical development is normal, nutrition status is fine. There is no injury or bleeding spots of his skin and mucosa, the skin below the ankles were dark red, with lower skin temperature, there was hyperesthesia of the feet, he had die blausucht, there was no congestion of throat, no swelling tonsil. The chest development was symmetrical, breathing sounds of both lungs were weak, especially the lower lungs part, the breathing sounds can be hear when he done deep breath, no obvious dry or moist rales. The heart beat is powerful with regular cardiac rhythm, with no obvious murmur in the valves. Abdomen was flat, there is 20cm scar post surgery of the middle abdomen, touch was soft, no masses or tenderness. His liver and spleen are in normal position, shifting dullness was negative. Vertebral column is normal, there was pitting edema below the ankles, with local skin lower temperature. Arteria dorsalis pedis can be touched, hyperesthesia of the feet skin.

Nervous System Examination:
Patient was alert and his mental condition is fine, slur speech, the memory, calculation and orientation ability are normal by examination. Both pupils were equal in size and round, diameter as 3.0mm, react well to light, eyeballs can move freely, no nystagmus. Bilateral forehead wrinkle and nasolabial groove are symmetrical, tongue out is normal, tongue muscles can move nearly normal, show teeth is normal. His tongue can touch the cheek powerfully, chewing ability is slightly weak, there is slightly air leakage when he bulge the cheek. Soft plate can lift powerfully, he can close eyes powerfully. Neck is soft, shrug ability was weak, he can turn neck powerfully. The right upper limb distal muscle power is 4- degree; proximal muscle power is 3 degree, left upper limb distal muscle power is 4 degree, proximal muscle power is 3+ degree, right hand grip force is 3- degree, left hand grip force is 3 degree. Lower limbs muscle power is 3- degree. There are obvious muscle atrophy of the bilateral shoulders, upper limbs, hands thenar muscles and lower limbs. Muscle tone decreased. Bilateral biceps reflex and radial periosteal reflex can not be induced by examination, patellar tendon reflex can not be induced, bilateral Palm-jerk reflex is negative, Rossilimo sign of both sides are negative, the left side Hoffmann sign is positive, of right side is negative. Babinski sign of both sides is neutral. Patient can not perform the finger to nose test because of the weakness, he can perform the fast alternate movement clumsy, he can not do the right side finger opposite movement, while his left hand can do the finger opposite movement slowly except the little finger. He can not do the Heel-knee-tibia test, the meningeal irritation sign is negative.

After the admission, he received related examinations and diagnosed with ALS. He received 3 times nerve regeneration treatment to repair his damaged nerves, replace dead nerves, nourish nerves, regulate his immune system and improve blood circulation, with rehabilitation training.     

After 14 days’ treatment, he had better exercise tolerance, his respiration functions was improved, his blood oxygen saturation increased to 95-98%, both of his upper limbs were flexible, he could raise arms easier, the right hand grip force can reach 3 degree, the left hand grip force can reach 3+ degree, he can bend the hip and the knees for longer time, his skin in foot is less sensitive.

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