Viorel Virlan-Amyotrophic lateral sclerosis (ALS)-(Romania)

Patient name: Viorel Virlan
Gender: Male
Age: 52 years old
Nationality: Romania
Diagnosis: Amyotrophic lateral sclerosis

Condition on admission:
The patient began left upper limb weakness and muscle bundle fibrillation two and a half years ago, and the disease gradually involved his both upper limbs, muscle atrophy, weight loss, loss of 15kg in half a year, decreased exercise endurance of his both lower limbs, inability to stand on heel, and instability of one foot. He was admitted to hospital with amyotrophic lateral sclerosis. Riluzole was taken for 3 months but ineffective. He had a ten-year history of hypertension.

Admission for physical examination:
His heart rate 57 beats / min, his respiration 18 beats / min, his blood pressure 129/89mmHg. His height 186CM, his weight 84kg. His blood oxygen 95%. His development was normal and the nutrition was ordinary. No cyanosis on the lips. The chest was symmetrical, the breathing sound of both lungs was slightly weak, and no dry-wet rale was heard. The heart sound was strong and irregular, and no obvious murmur was heard in each valvular area of the heart. The abdomen was flat and soft, there was no tenderness and rebound pain, and the liver and spleen were not touched under the ribs. The dorsalis pedis artery fluctuated well.

Nervous system physical examination:
The patient’s mind was clear, his spirit was fine. His articulation was OK. The ability of calculation, memory and orientation were all normal. His double pupil diameter was 3mm, sensitive to light, flexible eye movement, no nystagmus. His bilateral nasolabial sulcus and forehead lines were symmetrical, his tongue extension was in the center, and the tongue muscle atrophied obviously. The gills were strong, the chewing force was normal, his bilateral soft palate was lifted forcefully, and the uvula was in the middle. He could turn his neck and shrug his shoulders forcefully. His left upper limb muscle strength was grade 3, his left hand wrist strength and grip strength were grade 2 +, his left hand interfinger muscle strength was grade 2; his right upper limb muscle strength was grade 3 +, his right hand wrist strength and grip strength were grade 3, his right hand interfinger muscle strength was grade 2 +; his muscle strength of both lower limbs was grade 4, his standing balance ability was OK, but he could not stand by his heel and toes; his standing on one foot was unstable. The muscle tension of the extremities was basically normal. His muscles extremities and interphalangeal muscles of both hands atrophied. The tendon reflex of the extremities was weakened. His bilateral Hoffmann sign was negative, left foot Babinski sign was positive, right foot Babinski sign was weakly positive. The finger-nose test of both hands was stable and accurate, the finger-to-finger test and rotation were slightly clumsy, and the completion of bilateral calcaneal knee-tibial test was OK. His meningeal irritation sign was negative.

Treatment process:
The patient was exactly diagnosed as "amyotrophic lateral sclerosis" when his admission. During hospitalization, neural stem cells were given to repair motor nerve injury, mesenchymal stem cells were given to support his nutrition, endocrine and immune abilities, assisted with Edaravone, riluzole, neurotrophic factor and other drugs CAST treatment, and combined with comprehensive rehabilitation treatment.

After treatment:
The motor function of the patients was significantly improved, his lifting force of both arms was enhanced, his weight-bearing capacity was enhanced, the grip strength of his both hands was enhanced, and the fine movement of his fingers was improved, which could resist resistance. His left upper limb muscle strength was grade 4 +, his left hand wrist strength was grade 4, his left hand grip strength was grade 5, his left interfinger muscle strength was grade 3 +, his right upper limb muscle strength was grade 5, his right hand wrist strength was grade 4, his right hand grip strength was grade 5, his right interfinger muscle strength was grade 4. The muscle strength of his both lower limbs was grade 5. The completion of his finger test and rotation test was improved, and the speed was accelerated. He could stand on his toes for more than 5 seconds and on his heel for about 5 seconds. His each leg could stand for more than 10 seconds and could resist resistance. The volume of his atrophic muscle increased, the body weight gradually increased by 2 kg during hospitalization, and his mental state, energy, physical fitness and exercise endurance were significantly improved. His cardiopulmonary function was improved, blood oxygen saturation was 98%, blood pressure was between 110-130pm 60-80mmHg, and heart rate was between 60-70 beats / min.