Michael Callahan-Amyotrophic Lateral Sclerosis-(USA)

Name: Michael Callahan 
Sex: Male
Nationality: USA
Age: 69Y
Diagnosis: 1. Amyotrophic Laternal Sclerosis (ALS) 2. High Blood Pressure grade 2 (high risk)
Discharge Date: 2019/10/18

Before treatment:
The patient had no obvious cause of left hand lifting and grasping weakness in January 2018 and the weakness of the left arm gradually worsened. Two months later he went to the neurology department and after the relevant examinations in April they diagnosed him as having "amyotrophic lateral sclerosis.” The doctor gave "riluzole" orally with no effect. The patient's condition still progressed gradually to weakness of the right arm in May. In January 2019 walking weakness with muscle atrophy gradually appeared in both legs. The patient lost the ability to walk independently in May. At present it is difficult for him to lift his arms, his hands are unable to write, use knives or forks or other functions and he was unable to take care of himself. He has had a history of high blood pressure for many years.

Admission PE:
Bp: 146/88mmHg, pulse rate: 74/min, breathing rate: 19/min, body temperature: 36.2 degrees, height: 190cm, weight: 104kg. The patient has normal physical development, good nutrition, no cyanosis of the lips, a symmetrical chest and slightly reduced chest mobility. There was clear respiratory sounds of both lower lungs, no dry or moist rales heard, no bulging of precordia, strong heart sounds, regular heart rhythm and no obvious murmur heard in the valves. He had a bulging abdomen, no tenderness or rebound tenderness, no masses, normal liver and spleen, negative shifting dullness, normal spinal column, no edema in the legs and normal dorsal artery pulsation of feet.

Nervous System Examination:
The patient was alert, had good spirit, clear speech, normal memory,  calculation and orientation abilities. Both pupils were round and equal in size, with a diameter of 3 mm, reacting sensitively to light and with free eyeballs movement There was a symmetrical forehead wrinkle and nasolabial fold, tongue is in the middle when extended, no muscle atrophy of the tongue, free tongue movement, no air leakage with cheeks-puffing, normal chewing, unremarkable soft palate-lifting and no deviation of the uvula. He had a soft neck, slightly weak neck-turning and shrug. With grade 1+ muscle power of proximal left arm, grade 2+ of distal left arm, left wrist-lifting disabled, grade 2- muscle power of proximal right arm, grade 3- of distal left arm, grade 3- of right wrist-lifting power, grade 2 of left gripping power, grade 3- of right gripping power. He had grade 3- muscle power of both legs, normal muscle tone of the 4 limbs with muscle atrophy observed in both arms, bilateral major and minor thenar and bilateral hands’ interosseus. There was no tendon reflex of the 4 limbs, a negative Hoffmann sign, Rossolino sign and Babinski sign bilaterally. He was  unable to do the finger to finger test on the left side, unable to do the finger to finger test with the right little finger; unable to do the fast alternate and finger to nose test bilaterally; unable to do the heel-knee-tibia test bilaterally. There was a negative meningeal irritation sign.

After the admission he received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair his damaged nerves, replace dead nerves, nourish nerves (ganglioside, nerve growth factors, Edaravone and neurotrophic factors), improve body environment, regulate his immune system and improve blood circulation. This was combined with rehabilitation training.   

After 14 days treatment his movement endurance got better, his respiration function got better, the muscle power of the arms was increased and he could raise his arms easier. The muscle power of the left arm's proximity increased to grade 2+, muscle power of right arm's proximity increased to grade 3. The muscle power of the legs was increased 20%, he could now move his legs easier and walk better. The muscle power of his back, waist and abdomen increased and his walking balance got better.

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