Ms.Hidayat-Motor Neuron Disease-(Iraq)

Name: Ms.Hidayat
Sex: Female
Nationality: Iraqi
Age: 38Y
Diagnosis: Motor Neuron Disease (MND)

Before treatment:
The patient felt weak and tired 5 years ago so she went to a local hospital but did not get better. 2-3 months later she fell down a lot so she did some examinations and was diagnosed with MND 2 months later. Her disease progressed quickly, her arms and left leg were affected and she was unable to walk 4 years ago. She also had problems with speaking and swallowing 3 years ago and  is now unable to speak clearly. At present she is unable to stand, walk, sit up or turn over. She eats semi-liquid food and always chokes when drinking. She is always short of breath.
Her spirit, sleep, urination and defecation functions are normal.

Admission PE:
Bp: 90/66mmHg, Hr: 70/min, breathing rate: 20/min, body temperature: 36.6 degrees. Nutrition status is good with normal physical development. There is no injury or bleeding spots of her skin and mucosa and no blausucht. The chest development is normal, the respiratory sounds in both lungs were clear, but it is lower in the right lower lung area. There were no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was flat and soft with no masses or tenderness. The liver and spleen were normal, shifting dullness is negative. The spinal column is normal and there was no edema in either leg.

Nervous System Examination:
Patient was alert and her mental status is good but she has slurred speech. Her memory, orientation and calculation abilities were normal . Both pupils were equal in size and round, diameter of 3 mm, react well to light and the  eyeballs can move freely. No nystagmus. Bilateral forehead wrinkle and nasolabial fold are symmetrical. When she opens her mouth it is easy for her  to have jaw dislocation. She can make her tongue extend out but tongue muscle movement was limited with tongue muscle atrophy. Showing the teeth was normal, her tongue cannot touch the cheek powerfully, chewing ability was weak and she  cannot bulge the cheeks. The bilateral soft palate cannot lift well but she can close her eyes powerfully. The neck was soft, shrug ability was poor. Right arm proximal side muscle power was 3- degrees, distal side muscle power was 3 degrees. Left arm proximal side muscle power was 2 degrees, of the distal side 3- degrees. Both hands grip force was 2 degrees. Muscle power of the legs was 3- degrees. Muscle tone of the arms was normal and of the legs was higher. There were muscle spasms in the legs. There is severe muscle atrophy of both shoulder and back muscle groups, bicipital muscle, triceps muscle, thenar muscles, palm and finger interosseus muscles, and the leg muscle groups. The arm biceps reflex and radial periosteal reflex are active, the patellar tendon reflex in the legs is hyperactive, bilateral Palm-jaw reflex were positive. Hoffmann sign of both sides was positive, Rossilimo sign of both sides was positive, Babinski sign was positive. She can not perform the coordinated movement test using her arms and legs because of weakness. The meningeal irritation sign was negative.

After the admission, she received related examinations and 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 14 days treatment she speaks clearer and louder, has less choking and eats quicker. The proximal side arm can move with much more flexibility, the hands grip power increased 1 level, she is able to raise her arms above the bed, is able to turn over her body, sit up easier and the  muscle spasms in the legs after exercise alleviated. She is able to raise her legs above the bed, her joints are flexible, she is able to stand up from a sitting position and she can now walk for a short distance.

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