Ms.Sue-Amyotrophic Lateral Sclerosis-(Holland)
Name: Ms.Sue
Sex: Female
Nationality: Dutch
Age: 55Y
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)
Drug Allergy: Penicillin
Before treatment:
The patient's right hand had weakness and atrophy in July 2014. Her condition got worse and in 2016 she had proximal end muscle weakness of the arms. 1 year later her left hand displayed weakness and atrophy. She went to hospital and had an EMG in March 2016 where she was diagnosed with Amyotrophic Lateral Sclerosis (ALS). She did rehabilitation training but her disease did not improve. For now, it is difficult to raise her arms, she is able to walk but slowly and she couldn’t take care of herself well. She wants a better life so she came to our hospital.
Her appetite, sleep, swallowing functions and weight are all normal. Her bladder and bowel functions are normal.
Admission PE:
Bp: 126/83mmHg, Hr: 85/min, breathing rate: 19/min, body temperature: 36.8 degrees, blood oxygen saturation was 94-95%. Nutrition status is normal and she has normal physical development. There is no injury or bleeding spots of her skin and mucosa, no blausucht. Chest develop is normal, the respiratory sounds in both lungs were clear with no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was bulging but with no masses or tenderness. Her liver and spleen were normal, shifting dullness test is negative. There was pitting edema of feet.
Nervous System Examination:
Patient was alert and her spirit was slightly down. She had clear speech, her 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. No nystagmus. Bilateral forehead wrinkle and nasolabial fold are symmetrical, her tongue is in middle and with no tongue muscle atrophy. She can show her teeth normally but her tongue can not move in a flexible manner. She can bulge her cheeks but with slight weakness, her chewing ability is good and the soft palate can lift powerfully. Her neck muscles are soft, she can move her head freely but the right side is not as strong as normal. Patient can shrug but slightly weaker than normal. Muscle power of proximal upper limbs are 3+ degrees, the distal abductor muscles power is 3 degrees, adductor muscle power is 2 degrees. The grip force of both hands are 4- degrees, the first 3 fingers muscle power are much weaker than ring finger and little finger on both hands. Muscle power of the legs was 4- degrees. Muscle tone of all 4 limbs was normal. Tendon reflex of the arms is lower than normal and of the legs is slightly lower than normal. There was middle degree muscle atrophy of all 4 limbs, Hoffmann sign of both sides are negative; Babinski sign of both sides are negative. She cannot perform finger to nose test as normal. The fast alternate movement of both hands are slow, she can only perform the finger opposite movement with the first 3 fingers. The bilateral Heel-knee-tibia test is slow, Meningeal irritation sign is negative.
Treatment:
After the admission Ms. Sue received related examinations and was diagnosed with ALS. She received 3 times nerve regeneration treatment to repair her damaged nerves, replace dead nerves, nourish nerves, regulate her immune system and improve blood circulation. This was done along with rehabilitation training.
Post-treatment:
After 14 days' treatment the patient feels that her body movement ability had some positive changes. Her spirit, energy and exercise tolerance were all improved. The muscle power of all four limbs has improved, the grip force of both hands increased to 4 degrees, muscle power of the legs is now 4 degrees. The level of maintaining the blood oxygen concentration was 95-97%.
