Najia Ramadam-Amyotrophic lateral sclerosis (ALS)-(Syria)

Patient name: Najia Ramadam
Gender: Female
Age: 64 years old
Nationality: Syria
Disease: Amyotrophic lateral sclerosis (ALS)

Admission:
Mainly due to "progressive muscle weakness of the right upper limb with muscle atrophy for more than 7 months" as "amyotrophic lateral sclerosis" admission. The patient's right hand became ill 7 months ago, gradually involving the right forearm and upper arm, muscle weakness, muscle atrophy, and muscle bundle tremor.

Physical examination:
Blood pressure 144/91mmHg, pulse 80 beats / min, 20 breaths / min, blood oxygen 96%. Normal development and good nutrition. The lips were not cyanotic and the pharynx was not red and swollen. Both lungs breathe clearly. There was no eminence in the precordial region, strong heart sound, uniform rhythm, and no murmur in each valvular area of the heart. The abdomen was flat and soft, and the liver and spleen were not enlarged. There was physiological curvature of the spine and fractures of the right humerus and scapula. There was no edema in both lower limbs and the dorsalis pedis artery fluctuated well.

Physical examination of the nervous system:
Clear spirit and good language. The calculation ability and orientation ability were normal. Double pupil diameter 3mm, sensitive to light, flexible eye movement, no nystagmus. Bilateral frontal striations were symmetrical, tongue extension was in the middle, and there was no atrophy of tongue muscle. The bilateral soft palate was lifted forcefully. Soft neck, turning neck and shrugging shoulders forcefully. The muscle strength of left upper limb was grade 5, muscle bundle fibrillation could be seen and left hand grip strength were grade 4, right upper limb muscle strength was grade 1 +, right hand grip strength was grade 1, muscle atrophy and muscle bundle fibrillation could be seen in right upper limb. The muscle strength of both lower limbs was grade 5. The limbs feeling was normal. The biceps reflex of the left upper limb was active, but the radial periosteal reflex of the right upper limb was not induced. The tendon reflexes of both lower extremities were normal. Bilateral Hoffmann sign was positive, left Babinski sign was neutral, right Babinski sign was positive. The rotation test on the left finger nose was normal, while the rotation test on the right finger nose could not be completed. The bilateral calcaneal knee tibia test was normal. 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 motor function of both upper limbs was significantly improved, the muscle strength of both upper limbs was improved, the muscle strength of the right upper limb was grade 2, the raising height of the right forearm was increased 10cm, the grip strength of both hands was increased, the grip strength of the left hand was 4 +, the grip strength of the right hand was 2 +, and the energy, physical fitness and exercise endurance were improved.