Nikola Mihajlović-Amyotrophic lateral sclerosis (ALS)-(Serbian)

Patient's Name: Nikola Mihajlović
Gender: Male
Age: 32 years old
Nationality: Serbian
Diagnosis: Amyotrophic lateral sclerosis (ALS)

Admission status:
The patient was admitted due to the progressive weakness of his limbs over the past 2 years, with exacerbation and dysarthria, as well as a decline in respiratory function over the past 3 months. The diagnosis is "amyotrophic lateral sclerosis" (ALS).

Inpatient physical exam:
Patient's heart rate was 68 beats/minute, respiratory rate was 25 beats/minute, and oxygen saturation was 94-95%. He was of a thin build. His respiratory movement was reduced, and there were no obvious dry or moist rales heard. His heart sounds were strong, regular, and without murmurs. His abdomen was flat and soft, and the liver and spleen were not palpable.

Neurological exam:
The patient was clear-headed and in good spirits. His speech was weak and articulation was unclear. His memory and calculation abilities were normal. His eye movements were flexible in all directions. His tongue strength was weak, and there was obvious atrophy of the tongue muscle with fasciculation. His chewing strength was weak. The bilateral soft palate lift was strong, and the uvula was centered. His neck and shoulder muscles had strength grade 4. His left upper extremity had strength of grade 3, while his wrist strength was grade 3, with hand grip strength of grade 2. His right upper extremity had strength of grade 3-, wrist strength of grade 3-, and hand grip strength of grade 2-. His lower extremities had strength of grade 3, and he had difficulty getting up from a sitting position and could not perform single-leg standing. His muscle tone was slightly elevated, and there was muscle atrophy present in all four limbs. His deep and superficial sensation was normal. His lower limb tendon reflexes were exaggerated. His limbs had positive pathological signs. His hand rotation test was slow and clumsy, and he could not complete the finger to finger test due to the weakness. His finger to nose test was also difficult to complete due to the weakness. His bilateral heel-knee-thigh test was less stable and accurate. His meningeal irritation signs were negative.

Treatment process:
The patient was admitted with a clear diagnosis of "amyotrophic lateral sclerosis". During his stay in the hospital, he received nerve stem cell therapy to repair motor nerve damage, mesenchymal stem cell therapy to enhance nerve nutrition, endocrine, and immune support, and adjuvant use of drugs such as edaravone, riluzole, and neurotrophic factors, along with comprehensive rehabilitation treatment.

Post-treatment:
The patient's motor function has improved significantly, with overall improvement of 30% in limb muscle strength. His respiratory function has improved, with a blood oxygen saturation level of 96-98%. His voice has become louder. His upper limb muscle strength is grade 3+, with a significant increase in arm elevation and hand grip strength of grade 3+. His lower limb muscle strength is grade 4, and he can stand up from a low seated position independently, and can complete single-leg standing. His energy, physical stamina, and exercise endurance have improved, and his muscle volume has increased.