Ayesha Hossain-Motor Neuron Disease-(Bangladesh)

Name: Ayesha Hossain    
Sex: Female
Nationality: Bengalese
Age: 54Y
Diagnosis: 1. Motor Neuron Disease (MND) 2. Hypertension (2 degree) 3. Chronic Gastritis

Before treatment:
The patient felt weak in her hands 1 year ago, her arms and legs were also getting weaker day by day. She went to a local hospital and did EMG, MRI and other examinations and was diagnosed with MND. It was hard for her to swallow food 6 months ago, sometimes she choked, she was unable to speak clearly and it was hard for her to breathe. She was unable to walk 4 months ago and at present she is unable to stand, walk, sit up or turn  her body over.  She cannot speak clearly, will choke when she eats and finds it hard to breathe in a lying position.
She sleeps well, has a semi-liquid diet, her urination and defecation functions are normal, she has had hypertension for many years.

Admission PE:
Bp: 143/88mmHg, Hr: 71/min, breathing rate: 29/min, body temperature: 36.5 degrees. Nutrition status is normal with normal physical development. There is no injury or bleeding spots of her skin and mucosa, no blausucht, no throat congestion, and her tonsils do not have swelling. Chest development is normal, the respiratory sounds in both lungs were clear, breathing sound of the lower lungs part is weak and 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 soft and flat, with no masses or tenderness.  Her liver and spleen were normal, shifting dullness test is negative, the spinal column is normal and there was mild edema in both legs.

Nervous System Examination:
Patient was alert but with slurred speech and her spirit was weak. She had obvious breathing difficulty when she was in a lying position. The memory,  orientation and calculation abilities were normal. Both pupils were equal in size and round, diameter of 3mm, react well to light, eyeballs can move freely and there was no nystagmus. Bilateral forehead wrinkle and nasolabial fold are symmetrical. Her tongue is in middle, she has tongue muscle atrophy, showing the teeth is normal. Patient can bulge her cheek with air leakage and her chewing ability is weak. The soft palate cannot lift powerfully. The pharyngeal reflex is not present. She can close her eyes as normal, the neck muscle is soft and she cannot shrug powerfully. The right arm proximal side muscle power was 3- degrees, distal side muscle power was 3 degrees, the right hand grip force was 3 degree. The left arm proximal side muscle power was 2 degrees, distal side muscle power was 2+ degrees, the left hand grip force was 2 degrees and her fingers cannot stretch in a normal manner. The left leg muscle power was 3- degrees, right side was 3 degrees. The 4 limbs muscle tone were basically normal. There was obvious muscle atrophy of her shoulder girdle, back, biceps muscle, triceps muscle, hand interphalangeal muscles, thenar muscles and legs. The arm biceps reflex and radial periosteal reflex were active. The patellar tendon reflex of the legs was active. Her bilateral palm-jaw reflex was positive, the Hoffmann and Rossilimo sign of both sides  were positive and the bilateral Babinski signs were neutral. Patient could not perform the 4 limbs coordinate movement 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 15 days treatment her breathing function improved with the breathing rate  slower at around 22-23/min and the breathing sounds were much clearer than before. Her 4 limbs, back and waist muscles were stronger, especially her left arm. The right arm proximal side muscle power was 3 degrees, distal side muscle power was 3+ degrees, the right hand grip force was 3+ degree. The left arm proximal side muscle power was 3+ degrees, distal side muscle power was 3 degrees and the left hand grip force was 3- degrees. She could stand and walk much easier.

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