Israr Ud Din-Motor Neural Disease-(Pakistan)

Name: Israr Ud Din
Sex: Male
Nationality: Pakistani
Age: 45Y
Diagnosis: Motor neural disease

Before treatment:
The patient felt weakness in his left hand without any reason. This was accompanied with fasciculation so he went to a local hospital and did an EMG. The result showed extensive anterior horn cell pathological changes. His condition became worse with his left arm having weakness one and half years ago then two months later his left leg was weak too. One year later, his right arm was showing weakness and he also had respiration problems. He went to hospital and did the EMG again and this time he was diagnosed with motor neural disease. 5 months ago he had speaking problems, he was unable to speak loudly. He had swallowing problems 1 month ago and so he ate less than before. At present he is weak, has fasciculation and muscle pain. He has swallowing problems and speaking problems, his respiration function is bad, he can’t breathe in a lying position. He wants a better life so he came to our hospital.
His spirit is good but he is unable to sleep well and he eats less than before. He defecates once in 3 days and he urinates 2-3 times each night.

Admission PE:
Bp: 135/92mmHg, Hr: 119/min, breathing rate: 22/min, body temperature: 36 degrees. Nutrition status is normal with normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht, no throat congestion and his tonsils do not have swelling. Chest develop is normal, the respiratory sounds in both lungs were weak especially the lower part of the lungs, there was no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and with no obvious murmur in the valves. The abdomen was soft and bulging with no masses or tenderness. The liver and spleen were normal, shifting dullness test is negative. The spinal column is normal, there was no edema in either leg. Sat was 89-90%.

Nervous System Examination:
Patient was alert and mental status was good. The memory, orientation and calculation abilities 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, his tongue is in middle, there is no tongue muscle atrophy. The tongue can press against the cheek powerfully and he can bulge the cheek as normal. Showing the teeth is normal and the bilateral soft palate can lift as normal. He can close his eyes powerfully, the neck if soft and he can turn the head as normal. The patient cannot shrug powerfully. The grip force of the left hand is 4 degrees, right hand is 5- degrees. There is muscle atrophy of the interphalangeal muscles. Right arm extensor muscle power is 4- degrees, left side is 4 degrees. The abductor, adductor and flexor muscles power are 5 – degrees, the  muscle power of the legs is 4 degrees. Muscle tone is normal, the sensory examination is normal. The bilateral biceps reflex and triceps reflex are active, patellar tendon reflex of the legs is active; the radial periosteal reflex and achilles tendon reflex cannot be induced by examination. The Hoffmann sign, Rossilimo sign and Babinski sign of both sides are negative. Finger to nose test, finger opposite test, heel-knee-tibia test and fast alternate movement examination are normal. The Meningeal irritation sign is negative.

After the admission he received related examinations and was diagnosed with motor neural disease. 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. This was done with rehabilitation training.     

After 14 days treatment his muscle power and exercise tolerance is increased. He can breathe better, his blood oxygen saturation increased to 95%, muscle pain has alleviated greatly, the grip force of the left hand increased to 5- degrees and muscle power of the legs increased to 5- degrees.

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