Brian Christopher Bender-Motor Neural Disease-(USA)

Name: Brian Christopher Bender
Sex: Male
Nationality: USA
Age: 47Y
Diagnosis: Motor Neural Disease (MND)
Discharge Date: 2019/10/11

Before treatment: 
The patient had dysphagia for 9 months and respiratory dysfunction for more than 3 months. He had no obvious cause of dysphonia 9 months ago so he went to the local hospital and was considered as having "cerebral infarction". The diagnosis was excluded after an MRI. The patient's dysphonia gradually aggravated and calf muscle spasm began to appear at the beginning of June and it was more common at night. 3-4 months ago he began to develop drinking water disorders, the speed of drinking water became slower and his breath was short after exercise. He can take care of himself, can walk independently, stand up, turn over, etc. but it was easy to fatigue and he had obvious shortness of breath after activities. His diet has not been affected for the time being. He was clearly diagnosed as having "motor neuron disease" at a local hospital but drug treatment was ineffective.
The patient's spirit is good, he has had sleep disorder for 6 years with sleep time of about 4 hours a day and it is easy for him to wake up at night. Diet, defecation and urination functions are basically normal.

Admission PE: 
Bp: 140/88mmHg,pulse rate: 69/min, breathing rate: 19/min, body temperature: 36.0 degrees, height: 183cm, weight: 84kg.The patient has normal physical development, good nutrition, no cyanosis of the lips, a symmetrical chest, reduced chest mobility and reduced respiratory sounds of both lower lungs with no dry or moist rales heard. There was no bulging of the precordia, strong heart sounds, regular heart rhythm and no obvious murmur heard of 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 of the legs and normal dorsal artery pulsation of the feet.

Nervous System Examination: 
The patient is alert, in good spirit, has clear speech with normal memory,  calculation and orientation abilities. Both pupils were round and equal in size, with a diameter of 3 mm and react sensitively to light. There is free eyeball movement, a symmetrical forehead wrinkle and nasolabial fold, his tongue is in the middle when extended, mild muscle atrophy of the tongue exists with free tongue movement. There is no air leakage with cheek-puffing, normal chewing, unremarkable soft palate-lifting and a left deviation of the uvula. He has a soft neck, normal neck-turning and shrug. With grade 4- muscle power of the left arm, grade 4 muscle power of the right arm, grade 3-  left gripping power and grade 4  right hand gripping power.  Grade 4+ muscle power of both legs, disabled dorsal foot flexion on the left side, reduced dorsal flexion and plantar extension on the right side and normal muscle tone of the 4 limbs. There is muscle atrophy of both arms, bilateral major and minor thenar and bilateral interosseus, normal 4 limbs sensation, reduced tendon reflex of the arms, no tendon reflex induced of the leg. With a negative Hoffmann sign, Rossolino sign and Babinski sign bilaterally, normal finger to nose test bilaterally, normal finger to finger test on right side, only finger to finger test done with the index finger on left side. There was clumsy fast alternate movement on the left side, normal fast alternate movement on right side, normal heel-knee-tibia test bilaterally and a negative meningeal irritation sign.

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

After 13 days treatment the patient's exercise endurance was improved, the muscle strength of his limbs rose, lifting force of both arms, flexibility of limb movement, range of motion of shoulder joint, grip strength of both hands and left finger movement flexibility were all improved. The finger to finger test could be completed with the index finger and middle finger and it was easier for him to grasp objects and hold a cup. His left foot dorsiflexion movement was better than before, foot lifting ability of both feet was improved, foot dragging condition was significantly improved, his walking posture was better than before and the walking distance was extended.

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