Sae-Hao-Motor neuron disease-Amyotrophic lateral sclerosis-(Thailand)

Patient name: Sae-Hao
Gender: female
Age: 40 years old
Nationality: Thailand
Disease: Motor neuron disease-Amyotrophic lateral sclerosis

The main reason was "progressive limb weakness with muscle atrophy for one and a half years, aggravated for a week" as "motor neuron disease-amyotrophic lateral sclerosis" admitted to hospital.

Admission condition:
Progressive limb weakness with muscle atrophy, muscle bundle fibrillation for one and a half years, dysphagia, drinking water choking, no sensory disturbance, no nausea, vomiting and so on. Partial thyroidectomy has been performed for thyroid nodules in the past. Deny the history of hypertension, coronary heart disease and diabetes. No family history.

Physical examination on admission:
Pulse 86 times / min, breathing 20 times / min, blood pressure 120/70mmHg. The development was normal and the nutrition was moderate. There were no yellow stains and bleeding spots on the skin. The range of motion of the chest decreased, the breathing sounds of both lungs were clear, the respiratory sounds of both lower lungs were weakened, and no dry-wet rales were heard. The heart sound was strong, the rhythm was uniform, and there was no murmur. The abdomen was flat and soft, and the liver and spleen were not enlarged.

Nervous system physical examination:
The spirit was clear, the voice was slightly low and weak. Memory and orientation were normal. Double pupil equal circle, diameter 3mm, sensitive to light, flexible eye movement, no nystagmus. The bilateral nasolabial sulcus and forehead lines were symmetrical, the tongue was in the middle, and the tongue muscle atrophied slightly, indicating that the teeth were not skewed and the strength of the tongue against the buccal part was weak. The force of cheek blowing was weak and the chewing force was weak. The lifting force of bilateral soft palate was weak, and there was salivation in the corners of the mouth. Moderate atrophy of limb muscles, bilateral thenar and interosseous muscles. The neck was soft, the forces of turning the neck and shrugging shoulders were weak. Left upper limb muscle strength was grade 2, left hand grip strength was grade 2; right upper limb muscle strength was grade 1 +, right hand grip strength was grade 1 +; left lower limb was grade 2, right lower limb was grade 1 +. The muscle tension of both lower limbs was slightly higher. The tendon reflexes of both upper limbs were weakened, the tendon reflexes of both lower limbs were slightly active, and the pathological reflexes of both lower limbs were positive. The left finger nose test was clumsy, the right finger nose test could not be completed; the two hands finger test was clumsy, the two hands quick rotation test, the calcaneus tibia test could not be completed. Meningeal irritation sign was negative.

Treatment process:
The diagnosis of amyotrophic lateral sclerosis was confirmed on admission. During hospitalization, neural stem cells were given to repair motor nerve injury, and mesenchymal stem cells were given nutrition, endocrine and immune support. Edaravone, riluzole, neurotrophic factor and other drugs were used, and combined with comprehensive rehabilitation treatment.

After treatment:
The swallowing function of the patient improved and the salivation basically disappeared. The respiratory function was better and the inspiratory sound of both lower lungs was stronger than before. The motor function of the extremities was better than before, the left upper arm could be lifted from the bed about 10cm, and could last for 5 seconds, the left hand could be raised above the forehead, the proximal muscle strength, distal muscle strength of the left upper limb and left hand grip strength reached grade 3; the proximal muscle strength of the right upper limb reached grade 2 +, the right upper arm could be lifted away from the bed 2cm, not sustainable, the right hand grip strength was grade 2 +, could hold the water cup. The muscle strength of the left lower limb was grade 3, and the flexion support could partially resist resistance; the muscle strength of the right lower limb was grade 3, which could be lifted off the bed surface and lasts for 3-5 seconds.

She could lift up her legs on the ground as the photo shows: