Ms. Almarri-Amyotrophic Lateral Sclerosis-(Saudi Arabia)

Name: Ms. Almarri 
Sex: Female
Nationality: Saudi Arabian
Age: 52Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis( ALS) 2. Diabetes (Type2)

Before treatment:
The patient felt pain in the thenar muscle, she also had muscle atrophy and couldn’t grasp objects. Her left arm became weak later and it was accompanied with fasciculation so she went to a local hospital and did an MRI and EMG. She was diagnosed with ALS. Her disease progressed and all of her four limbs were weak. One year ago she was unable to walk, 3 months ago she spoke slowly and her speech was unclear. 2 months ago she choked when she eating or drinking so she is only able to eat small pieces of food. At present she is unable to stand, walk or turn over her body. She can only move her right arm a little, her breathing and speaking ability is influenced and sometimes she is choking when eating or drinking.
Her spirit, sleep, urination and defecation functions are normal, she eats small and soft food.

Admission PE:
Bp: 154/94mmHg, Hr: 115/min, breathing rate: 20/min, body temperature: 36.9 degrees. The patient has normal physical development but her nutrition status was not good. There is no injury or bleeding spots of her skin and mucosa, chest development was good. The respiratory sounds in both lungs were very weak, especially the lower lungs part, 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 flat and soft, there was mass in the right lower abdomen that could be felt and it was tender  The liver and spleen were normal. There was slight pitting edema in both legs.

Nervous System Examination:
Patient was alert and her mental status is good. She had a slur in her speech, her 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 wrinkles are symmetrical. She can make her tongue extend around 0.5cm out of mouth, there is tongue muscle atrophy and her tongue could not move well, it could not touch the cheek as normal. Showing the teeth was normal. The chewing muscles were slightly weak, she could bulge the cheek but with air leakage. The bilateral soft palate could lift, she could close her eyes powerfully, neck was soft, shrug ability was decreased. Muscle power of the right arm was 2 degrees,  left arm was 0, there were only 3 fingers that could move slightly. Muscle power of her legs was 1 degree. There was muscle atrophy of the 4 limbs with muscle tone decreased. The bilateral biceps reflex, radial periosteal reflex and triceps reflex were decreased, legs patellar tendon reflex was reduced, bilateral Palm-jaw reflex, Rossilimo sign and Hoffmann sign were negative. Babinski sign of both sides was negative. The finger to nose test, fast alternate movement, finger opposite movement and heel-knee-tibia test could not be performed because of the weakness. The meningeal irritation sign was negative.

After the admission, she received related examinations and was diagnosed with 1. ALS 2. Diabetes (Type2). 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 with rehabilitation training.     

After 13 days treatment her right hand finger could move much better, she could move the thumb and index finger.

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