Edward Sihite-Motor neuron disease-(Indonesia)-Posted on Mar.4th, 2015

Name: Edward Sihite                
Sex: Male
Country: Indonesia
Age: 52 years
Diagnosis: Motor neuron disease. type 2 Diabetes
Date: Jan. 25th, 2015
Days Admitted to Hospital: 22 days

Before treatment:
Edward Sihite had left lower limb weakness 14 years ago with no apparent cause. His walking ability was affected and now he has difficulty using stairs. But he didn’t receive treatment. He had cerebrospinal fluid, electromyogram, muscle biopsy and spinal MRI 10 years ago and was diagnosed with” Motor neuron disease”. He was not on medication. 3 months ago, his weakness of left lower limb became worse, and that involved right lower limb and both upper limbs. He couldn’t walk well and regularly falls down. He wants to have a better treatment, so he came to our hospital. He was diagnosed with ”Motor neuron disease”.

He was in good spirit. His diet, sleeping, urination and excrement were normal. His speech and swallowing were good, no trouble with breathing. His weight was lighter.

Admission PE:
Bp: 134/89mmHg; Hr: 90/min. Br:19/min. Temperature: 36.5 degrees. His skin and mucous were complete without yellow stains or petechia. His pharyngeal was not congested. The tonsil was not enlarged. His thorax was symmetrical without deformity, and the breathing mobility was weak. The respiration of both lungs was weak with no dry or moist 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 and flat with no pressing pain or rebound tenderness. The liver and spleen were normal. His lumbar was over lordotic in sitting position. There was no edema in both lower limbs.

Nervous System Examination:
Edward Sihite was alert and his spirit was good. His 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. The forehead wrinkle pattern was symmetrical. The ability to close his eyes was strong. Both nasolabials were equal in depth, the tongue was centered in the oral cavity, the tongue muscles were atrophied unevenly without ventricular fibrillation. And the teeth were normal and shown without deflection, cheek blowing strength was normal. The muscles used for chewing were powerful. Both soft palates could be lifted, and the strength was strong. He had pharyngeal reflex. The muscle strength to hold his head was normal, and he could shrug his shoulder. Both triceps brachii atrophied, the left side was worse, other muscles were normal. The abductor muscle power of left upper limb was at level 4, right upper limb was at level 4-. The flexor muscle power of both upper limbs were at level 4+, the extensor muscle power of left upper limb was at level 3, right upper limb was at level 4. The grip of both hands was at level 4+. The muscle power to bend and extend hip, bend his knees were at level 5 and extend his knees was at level 3+. The muscle tension of his four limbs was a little lower. The tendon reflex and abdominal reflex of his four limbs disappeared. Both palm jaw reflex, Hoffmann sign, Rossilim and Babinski were all negative. The rough depth determination of both sides was normal. He could finish the finger-to-nose test, rapid rotation test and finger-to-finger and both legs’ heel-knee-tibia test were good. The meningeal irritation sign was negative. Oxygen saturation was 93-96%.

Treatment:
She was diagnosed with motor neuron disease and type 2 Diabetes. He received treatment to improve circulation, nourish neurons, improve immunity and we used non-invasive ventilator for breath. We also gave him daily physical rehabilitation.

Post-treatment:
After the treatment, his motor function of four limbs was better. The abductor muscle power of both upper limbs was at level 4. The flexor muscle power of both upper limbs were at level 5, the extensor muscle power of left upper limb was at level 3+, right upper limb was at level 4. The grip of both hands was at level 4+. The muscle power to bend and extend hip, bend his knees were at level 5, extend his knees was at level 4. The postures of sitting, standing and walking were better. His respiratory function was better; the oxygen saturation was 96-98% which was higher than before. His treatment was over and could be discharged now.