Shin Minwoo-Motor neuron disease-(Korea)-Posted on Mar.4th, 2015

Name: Shin Minwoo               
Sex: Female
Country: Korea
Age: 49 years
Diagnosis: Motor neuron disease
Date: Jan. 24th, 2015
Days Admitted to Hospital: 22 days

Before treatment:
In April, 2013 the patient had right upper limb weakness without any incitements. After electrophysiological examination on nerves, she was diagnosed with nerve injuries at wrist on the right side. She had the same examination result in August, and it got worse. In July, 2014, she was diagnosed with motor neuron disease in a Korean Hospital. She took many kinds of vitamins and coenzyme Q10. Now she could hardly control her neck or move her upper limbs. She could turn over and sit by herself. She could stand and walk. She chews normally, no trouble with swallowing or drinking. She wants to have a better treatment, so she came to our hospital and she was diagnosed with motor neuron disease.

She was in bad spirit and depressed. She couldn’t sleep well. Her urine and defecates were normal. She lost 7kg weight.

Admission PE:
Bp: 140/80mmHg; Hr: 86/min. Br: 19/min. Temperature: 36.6 degrees. His body type was good and well nourished. There was no ecchymosis or petechia on skin. Her pharyngeal was not congested. The tonsil was not enlarged. Her thorax was symmetrical. After the minimally invasive treatment of left breast, the range of motion of thorax was reduced. The respiratory sounds in both lungs were weak and in the lower lobe were clearly decreased. There were no obvious moist or dry rales. The heart sounds was strong, the rhythm of his heartbeat was normal. Hr: 86/min. There was no obvious murmur in the valves. The abdomen was soft with no pressing pain or rebound tenderness. The liver and spleen were normal. There was no edema in both lower limbs.

Nervous System Examination:
Shin Minwoo was alert and her speech was fluent. Her memory, calculation and orientation abilities were normal. Both pupils were equal in size and round, the diameter was 3 mms, both eyes had sensitive response to light stimuli. Both eyeballs could move freely. She had no nystagmus. The forehead wrinkle pattern was symmetrical. The ability to close her eyes was strong. Both nasolabials were equal in depth, cheek blowing strength was normal. The tongue was centered in the oral cavity,  muscles of tongue were not depauperated. The movement of tongue was inflexible. And the teeth were normal and shown without deflection. Both soft palates could be lifted, and the strength was strong. She swallowed well. Pharyngeal reflex reduced. The muscle of neck was soft, the muscle strength to look up, turned around were weak, and she couldn’t shrug her shoulder. The girdle muscular, sternomastoid muscle, the muscle groups on proximal end and remote end of both upper limbs, wasting of the thenar and hypothenar and metacarpophalangeal muscle all atrophied obviously. But the muscle in both lower limbs were normal. The abductor, extensor, flexor muscle, pronation and supination muscle power of left upper limb proximal end was at level 2. The muscle power of remote end adductor was at level 1+, abductor was at level 1, left hand grip was at level 2. The abductor, extensor, flexor muscle, pronation and supination muscle power of right upper limb proximal end was at level 2-. The muscle power of remote end adductor was at level 1, abductor was at level 1 and right hand grip was at level 1-. The muscle power of both lower limbs was at level 4. The muscle tension of four limbs was low. There was no tendon reflex on both upper limbs, the patella tendon reflex in left lower limb was normal and in right lower limb was active. Both ankle reflex was normal. The abdominal reflex disappeared. Both side pathological signs were negative. The rough depth determination of both sides were normal. She couldn’t finish the finger-to-nose test, rapid rotation test and finger-to-finger test. Both legs’ heel-knee-tibia test was good. The meningeal irritation sign was negative.

Treatment:
She was diagnosed with motor neuron disease. We initially gave her a complete examination. She received treatment to repair and revive nerves. Improve circulation, nourish neurons, we used non-invasive ventilator for breath. The pattern was ST, BiPAP, IPAP 10cmH2O, EPAP 5cmH2O. We also gave her daily physical rehabilitation.

Post-treatment:
The patient had angina, headache, and congestion of throat and tonsil mild swell. Her body temperature was normal. So she took oral antibiotic and got better. After the treatment, she can breathe well. The respiration of both lungs was clearer than before. The muscle power was a little better. She could move her right upper limb parallel to medial side in fractionation. The proximal end of right upper limb could be lifted away from bed for 1-2cm. The muscle power of proximal end was at level 3-, and the remote end was at level 2-. The muscle power of left upper limb proximal end was at level 2+. The left hand grip was at level 4, and the remote end was at level 1+. Both lower limbs muscle power was at level 5-. She felt she has more endurance when she was walking. Her treatment was over, she could be discharged.