Ms.Bruce-Amyotrophic Lateral Sclerosis(Israel)

Name: Ms.Bruce
Sex: Female
Nationality: Israeli
Age: 53Y
Diagnosis: 1. Amyotrophic Lateral Sclerosis(ALS) 2. Post Tracheotomy 3. Breathing Tract Infection 4. Post Gastrostomy 5. Hypertension (level 2)  6. Renal Insufficiency
Discharge Date: 2017/11/02

Before treatment:
The patient felt weak in her right hand 2 years ago. As the disease progressed her whole body became weak and she went to a local hospital and was diagnosed with ALS. She took Riluzole 50mg twice a day and it was not effective. She did a tracheotomy 1 year ago and she used a breathing machine (parameter PCV(A+TgV), Insptime 1.4s,Risetime 0.1s,BR:14,Peep:4.9). She couldn’t speak, used a gastric tube for food and had Gastrostomy surgery in August 2016. For now she is paralyzed, she needs help with washing, eating and dressing. She is unable to speak, uses a gastrostomy tube for food and uses a breathing machine.
Her spirit is good, she needs medicines to sleep, has urinary incontinence and constipation and she has had hypertension for many years.

Admission PE:
Bp: 150/90mmHg, Hr: 95/min, breathing rate: 19-25/min, body temperature: 37.2 degrees. Blood oxygen concentration was 89-93%. There was a tracheotomy in the neck, she uses a breathing machine, has mild blausucht and her face is flushed. Chest development is normal, the respiratory sounds in both lungs were lower than normal and there was Wheezy phlegm. The heart beat is strong with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was soft and bulging with no masses or tenderness and there was a drum percussion sound. The liver and spleen were normal and there was mild edema in the legs.

Nervous System Examination:
Patient was alert and she was anxious, she had mild edema of  bulbar conjunctiva. Both pupils were equal in size and round, diameter of 4 mm, react well to light, the eyeballs can move freely from left to right side while limited in upward to downward movement. Bilateral forehead wrinkle and nasolabial groove is symmetrical, her mouth is half open and she cannot close the mouth, she could not make her tongue extend out, the tongue muscle cannot move from left side to right side and there is tongue muscle atrophy. She cannot show her teeth, chewing ability was weak, the bilateral soft palate cannot lift. She cannot close her eyes, her neck was soft, she cannot turn the head or shrug. Muscle power of the 4 limbs was 0 degrees,  with low muscle tone in all 4 limbs. There is obvious muscle atrophy of thenar muscles and the interosseous muscle. Tendon reflex of the 4 limbs was decreased obviously. Bilateral Hoffmann sign was negative, Babinski sign of both sides was neutral. The meningeal irritation sign is negative.

After the admission she received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to activate the nerves, nourish nerves, anti oxygen radical, improve blood circulation, blood pressure control, anti-infection and  protect the renal function. This was combined with rehabilitation training.

After 14 days treatment the patient's infection was controlled, heart rate was 80/min, blood pressure 110-130mmHg, breathing rate 18-20 min and her blood oxygen was maintained at 95-98%. Her spirit was better, she can close her eyes and she now had 7-8 hours sleep each day. She could extend  her tongue out for 2cm and her swallowing function was better. The edema of bulbar conjunctiva and the legs disappeared. The renal function got back to a normal level.

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