Mr.Morde-Amyotrophic Lateral Sclerosis-(Iraq)

Name: Mr.Morde
Sex: Male
Nationality: Iraqi
Age: 52Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis(ALS) 2. Hypertension

Before treatment:
The patient felt weakness in his left leg in March 2014, then he felt weak in his left arm some days later so he went to a local hospital but was not diagnosed. His condition then got worse. The left side of his body became weak too so he went to hospital again in March 2015 where he did some more tests and was diagnosed with ALS. He took Riluzole 50mg twice a day but his condition did not improve. He also did plasma exchange treatment and multiple stem cells treatment and he felt a little better after each  treatment but his condition got worse fast. He was unable to walk 1 year ago, he was unable to speak clearly and he chewed slowly. He began to use bipap 6 months ago, IPAP 9cnH2O, EPAP 4cmH2O, Br:12/min. He ate only a liquid diet 3 months ago and he used Total Parenteral Nutriention 237mg*5. For now, his four limbs are weak, he has high muscle tension, he is unable to eat or put on clothes by himself, he can’t sit up, stand or walk and he can’t speak clearly.
His spirit is good, he uses medicine to sleep. His urination and defecation functions are normal, he has lost 11-13kgs.

Admission PE:
Bp: 130/86mmHg, Hr: 90/min, breathing rate: 18/min, body temperature: 36.8 degrees. He was bedridden but had normal physical development and his nutrition status was normal. There is no injury or bleeding spots of his skin and mucosa. Chest development was sound but the chest movement range decreased when he was breathing. The respiratory sounds in both lungs were normal with 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 bulging and soft with no mass or tenderness. The liver and spleen were normal. The shifting dullness was negative, spinal column was normal and there was no edema of his legs.

Nervous System Examination:
Patient was alert and his mental status was good. He had a slur in his speech, the memory,  orientation and calculation abilities were normal . Both pupils were equal in size and round, diameter of 3.0 mm, react well to light and the eyeballs can move freely. Bilateral forehead wrinkle are symmetrical. He could not make his tongue extend out to his lip on the side, had tongue muscle atrophy, showing teeth was normal. He could bulge the cheek but with air leakage, chewing ability had declined obviously, the soft palate could not lift powerfully. There was muscle atrophy in both shoulder girdles, the arms, thenar muscles, and hands interosseous muscles. Neck was soft and he could not shrug his shoulders well. The muscle power of the arm proximal side was 0 degrees, of the distal side was 1 degree. The wrist could move and the fingers of both hands could move lightly. The patient could not grasp or complete the finger opposite test. Muscle power of the legs proximal side was 0, of distal side was 1 degree. Muscle tone of the arms were normal and in the legs increased. The left side biceps reflex and radial periosteal reflex could not be induced by examination. Right side biceps reflex was reduced, both leg  patellar tendon reflex and tendon reflex could not be induced. The bilateral Palm-jaw reflex were positive. Hoffmann sign of both sides were negative, both sides Babinski sign were negative. The patient could not perform the finger to nose test, fast alternate movement or finger opposite movement because of weakness. The heel-knee-tibia test could not be done and the meningeal irritation sign was negative.

Treatment:
After the admission he received related examinations and was diagnosed with 1. ALS 2. Hypertension. 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.     

Post-treatment:
After 14 days treatment his speech is clearer, his swallowing function is better and he finds it easier to breathe. His finger movement improved and the feet dorsal movement range was greater than before.

 

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