Irina Banica-Amyotrophic lateral sclerosis (ALS)-(Romanian)

Patient's name: Irina Banica
Gender: Female
Age: 52 years old
Nationality: Romanian
Diagnosis: Amyotrophic lateral sclerosis (ALS)

Presenting condition:
The patient has had progressive weakness in her left upper limb for the past one and a half years, with difficulty raising her arm for touching objects, and she was diagnosed with "amyotrophic lateral sclerosis" and taken treatment with "riluzole" by a local hospital with no obvious effect. Her disease still continued to progress. Currently, her both upper limbs had weak muscle power, especially the left upper limb. She was unable to lift her left arm. Her left hand fingers were almost unable to grasp, and there was stiffness in joint movements. Her lower limbs had normal muscle power, allowing her to stand and walk independently. She had atrophy in her left upper limb with occasional muscle twitching. She had no history of chronic diseases, infectious diseases, or trauma.

Admission examination:
Pulse rate of the patient was 65 beats per minute, respiratory rate was 18 breaths per minute, blood pressure: 121/77mmHg, and blood oxygen saturation was 92%. She was of normal development and good nutrition. Her lips were not cyanotic, and there was no redness or swelling in her pharynx. Her thoracic cage was symmetrical, the respiratory movement of the thoracic cage was basically normal, and both lower lungs had clear respiratory sounds without obvious dry or moist rales. Her heart sounds were strong, regular, and there were no murmurs in any valve area of the heart. Her abdomen was flat and soft, and the liver and spleen were not palpable. There was no edema in her both lower limbs.

Neurological examination:
The patient was clear-headed and had normal mental status. Her speech was clear. Her calculation, memory, and orientation were all normal. Her pupils were 3mm in diameter and responded well to light. Her eye movements were flexible in all directions. Her nasolabial and frontotemporal folds were symmetrical bilaterally. Her tongue was protruded normally with normal muscle atrophy, and her tongue movement was normal. She had strong cheek blowing and normal chewing force. She drinked without choking. Her bilateral soft palate lift was strong, and her uvula was centered. She had a muscle strength of grade 4 in her neck rotation and shoulder shrug, grade 2 muscle strength in her upper left limb, grade 2 grip strength in her left hand; Her right upper limb had a muscle strength of grade 4; Her lower limbs had a muscle strength of grade 4+. She had atrophy of the muscles in her upper left limb, accompanied by muscle twitching. Her sensory function was normal in all four limbs. Her muscle tone was basically normal in all four limbs. Her tendon reflexes were weakened in all four limbs, and the pathological signs were positive in both sides. Her left finger-nose test was poorly completed, and the pointing and rotation movement tests were basically unable to be completed due to muscle weakness. Her right finger-nose, pointing, and rotation movement tests were completed well. Her toe-knee-shin test of both legs was completed well. She had a negative sign of meningeal irritation.

Treatment process:
The patient was admitted with a clear diagnosis of "amyotrophic lateral sclerosis". During her hospital stay, she received neural stem cell repair for motor nerve damage, mesenchymal stem cell for nutrition, endocrine, and immune support, with adjuvant application of drugs such as edaravone, riluzole, and neurotrophic factors. Additionally, she received comprehensive rehabilitation treatment.

Post-treatment:
The patient's motor function has significantly improved. Her neck rotation and shoulder shrug muscle strength has returned to nearly grade 5, and her left upper limb muscle strength has improved to grade 3+. She is able to perform horizontal lifting of her left upper limb when standing, and her upper arm can be fully and easily lifted when in a supine position. Her hands can now reach the top of the head. Her grip strength in her left hand has improved to grade 4, with significant improvement in the flexibility of her fingers and the ability to resist certain resistances. Her right upper limb and both lower limbs have nearly grade 5 muscle strength. There has been a noticeable improvement in her left arm muscle volume, and the dexterity, as well as joint mobility of her both hands. She showed significant improvement in coordination testing on her all four limbs throughout her physical examination and had marked improvements in her energy, physical stamina, and motor endurance.