Rayman Jessica-Charcot-Marie-Tooth (CMT) Disease-(American)

Patient's name: Rayman Jessica
Gender: Female
Nationality: American
Diagnosis: Charcot-Marie-Tooth (CMT) Disease

After admission:
The patient was admitted with a chief complaint of "progressive distal muscle atrophy and weakness of limbs for 25 years, with an exacerbation for the past 8 months", with a diagnosis of "Charcot-Marie-Tooth (CMT)". Her main symptoms included: progressive distal muscle atrophy and weakness in both limbs, balance impairment that caused her to sway after standing independently for about 1 minute, poor balance ability, requiring support to prevent falls, poor fine motor coordination in both hands, poor grip strength, especially in the right hand, weakness in dorsiflexion and plantarflexion of the feet, and significant muscle atrophy in distal limbs. She has a history of hyperlipidemia and is allergic to Augmentin (amoxicillin clavulanate potassium).

Physical Examination at Admission:
The patient's blood pressure was 131/71mmHg, and her heart rate was 70 beats per minute. She was in good nutritional condition, and general examination of the internal medicine system did not reveal any significant abnormalities.

Neurological examination:
The patient was clear headed and in good spirits. Her speech was clear. Her memory, calculation, and orientation were normal. Her pupils were 3.0mm in diameter and responded promptly to light stimuli. Her bilateral eye movement was normal without nystagmus. Her nasolabial furrows were symmetrical and she had good muscle strength when closing her eyes. She showed her teeth straight and her soft palate elevated well bilaterally. She had atrophy of the forearm muscles in both upper limbs, including the radial and ulnar muscles on the outer and inner sides of the arms, the palm muscles of both hands, the muscle groups of the shin and calf of both lower limbs, and the muscle groups of the lower third of both thighs. Additionally, she had atrophy of the muscle groups of her feet, and her right side was more affected. Her proximal upper limb muscle strength was grade 3+, while her distal upper limb muscle strength was grade 3- on her left arm and grade 2+ on her right arm. Her grip strength was grade 2+ on her left hand and grade 2 on her right hand. Her proximal lower limb muscle strength was grade 3+, while her distal left lower limb muscle strength was grade 3-. She had grade 2+ distal muscle strength in her right lower limb. Her muscle tone of upper and lower limbs were both generally normal while slightly low of both her upper and lower limb muscles. Her tendon reflexes of the limbs were diminished. She was negative for pathological reflex. Moderate sensilla pain insensitivity was present at her toe parts of the feet. Her finger-nose test, finger to finger, and rapid alternating test were moderately clumsy on both sides. Her heel-knee-thigh test was slightly clumsy on both sides. She is negative for meningeal irritation sign.

Treatment Process:
The patient was treated with a combination of neural stem cells and mesenchymal stem cells, with the aid of the CAST therapy, including nerve repair, nerve nutrition, circulation improvement, immune regulation, comprehensive rehabilitation, and other treatments.

Post-treatment:
The patient's condition has improved, with increased muscle strength in all four limbs, and muscle atrophy has improved. The bilateral hypothenar muscles have a more plump volume compared to before, and both hands have improved strength and flexibility, with the ability to grasp and grip fingers of others. She can resist a certain degree of resistance. Her proximal upper limb muscle strength is grade 4, her distal left upper limb muscle strength is grade 4+, her distal right upper limb muscle strength is grade 4, her left hand grip strength is grade 4, and her right hand grip strength is grade 3-4. Her proximal lower limb muscle strength is grade 4+, her distal left lower limb muscle strength is grade 4, and her distal right lower limb muscle strength is grade 4-. Her completion of finger-nose and rapid alternating tests in both hands has improved significantly compared to before, with faster movement speed and improved flexibility. Her balance function has improved compared to before, with increased stability during walking and increased endurance. Her blood lipid levels have decreased compared to before.