Dragan Bajic-Motor neuron disease -primary lateral sclerosis-(Serbian)

Patient's Name: Dragan Bajic
Gender: Male
Age: 43 years
Nationality: Serbian
Diagnosis: Motor neuron disease -primary lateral sclerosis

Condition upon admission:
The patient's main complaint was "progressive weakness, spasms, muscle atrophy, and muscle twitching in all four limbs for over two years" with a diagnosis of "primary lateral sclerosis, a type of motor neuron disease". Two years ago, he developed limb weakness, with the right limbs being more affected than the left, along with spasms, muscle atrophy, and muscle twitching. He had no significant difficulty swallowing or choking when drinking, but his speech was slow and his articulation was unclear. He had previously taken riluzole but had to discontinue it due to worsening symptoms. He was taking beta blockers (bisoprolol 2.5 mg daily) to control his heart rate. He also took trihexane (2 mg, daily) to reduce spasms.

On admission examination:
The patient's heart rate was 88 beats/min, respiratory rate was 20 breaths/min, blood pressure was 121/75 mmHg, and oxygen saturation was 97%. He was normal in development and had average nutrition. His lips were not cyanotic and there was no redness in the pharynx. His thorax was symmetrical, with slightly lower breath sounds on the bilateral lungs, especially on the right. There were no significant dry or wet rales on auscultation. His heart beats were regular, and there were no prominent murmurs in any valve regions of the heart. His abdomen was soft with no palpable liver or spleen. There were no signs of edema in his lower limbs.

Neurological examination:
The patient appeared clear-headed and in a normal state of mind. His speech was slow and articulation was unclear. His calculation ability, memory, and orientation were all normal. His pupils were round and reactive to light. His eye movements were normal with no nystagmus. His nasolabial folds and forehead wrinkles were symmetrical, with mild atrophy of his tongue muscle noted. His cheek puffing was normal, with sufficient strength in temporal and masseter muscles. His swallowing ability was also good, without significant choking. He could lift his bilateral soft palate effectively, with the uvula in the middle position. However, he had a weak neck rotation and shoulder elevation. His left upper limb muscle strength proximal muscle strength was grade 2, distal muscle strength was grade 2 +, his left hand grip strength was grade 2; his right upper limb proximal muscle strength was grade 2, his distal muscle strength was grade 3, his right hand grip strength was grade 2 +, his lying position could not lift both upper arms off the bed, his hands could not grasp. The muscle strength of his lower limbs was grade 3-. His muscle tension was high in both upper limbs and obviously high in both lower limbs. The muscles of his limbs atrophied and the muscle bundle quivered. Neither the finger nose test nor the calcaneus tibia test could be completed. His limbs sensation was normal. He has active tendon reflexes in both upper limbs and hyperreflexes in both lower limbs. His double Hoffmann sign was positive and his double Babinski sign was positive. His meningeal irritation sign was negative.

Treatment process:
The patient's admission diagnosis was "primary lateral sclerosis, a type of motor neuron disease", and during his stay in the hospital, he received treatment with nerve stem cell repair for motor nerve injury, mesenchymal stem cell supporing nutrition, endocrine, immune, and auxiliary application of drugs such as edaravone, riluzole, and nerve growth factors with CAST therapy, comprehensive rehabilitation treatment was also provided to him.

Post-treatment:
After treatment, the patient's motor function improved significantly, with his limb muscle strength increasing by 30%. His left upper limb, which could not lift off the bed before admission, now has muscle strength of grade 4- and can lift his arm above the bed by more than 15 cm. His left hand has a grip strength of grade 4-. His right upper limb has muscle strength of grade 3+ and can lift his arm above the bed by 10 cm. His right hand has a grip strength of grade 3+. His flexibility and mobility have significantly improved, along with his grasping ability and hand function, allowing him to hold a cup and use a walker. His lower limbs have muscle strength of grade 4 and can walk with the assistance of a walker. His left fingers can now complete the finger-to-nose test, while his both lower limbs can complete the heel-knee-shin test. The pain in his right ribs has significantly improved as well. His energy, physical stamina, and endurance have all improved significantly.