Maria Elena Ramirez-Optical neuromyelitis-(Venezuela)-Posted on December 1,2014

Name: Maria Elena Ramirez
Sex: Female
Country: Venezuela
Age: 38 years
Diagnosis: 1. Optical neuromyelitis  2. Antiphospholipid syndrome 3. Post thyroid carcinoma resection, Secondary low thyroid function 4. Iron deficiency anemia  5. Cardiac arrhythmia, Paroxysmal ventricular premature beats 

Date: November 7, 2014
Days Admitted to Hospital: 19 days

Before treatment:
          14 years ago, the patient appeared to have paroxysmal numbness of limbs, mobility limitation and paresthesia. When she visited a doctor, they only advice she was given was to have a good rest and do a rehabilitation training. She did not do any special treatment. After the intervals between 2-3 years the symptoms relapsed and the symptoms episode aggravated each time. 9 years ago, the patient was presented with paroxysmal visual impairment, so patient went to hospital and then did head, spinal cord MRIs and serum antibody examination. The diagnosis was optical neuromyelitis. She was given vein cortisol injection and impact therapy, and 2-3 months later, her condition improved gradually. In past five years, each time her symptoms relapsed, she was given the pulse therapy. After the pulse therapy, the symptoms were alleviated. Since about one year ago, patient’s condition has aggravated, her balance and coordination ability became worse gradually. She was not able take care of herself independently.

          Since the onset of disease, the patient had good spirit. Her diet and sleep were good. She had constipation but urine was normal. One month ago she caught cold, now she had mild cough symptom, without dizziness, nausea and vomit.

Admission PE: 
           Bp: 115/70mmHg; Hr: 70/min, Br: 19/min. Temperature: 36.5°. Maria Elena Ramirez’s figure and nutrition were normal. There were obvious pigmentation at the upper area of inner side of ankle at left leg. The pharyngeal had mild hyperemia, but tonsil had not swollen. The respiratory sounds of both lungs were clear, with no moist rales. The heart sounds were strong, but heart beats were not regular, ventricular premature beats were audible 5-6times/min. There was no obvious murmur in the valve area. The abdomen was flat and soft, with no obvious masses. There was no swelling in liver and spleen in palpation. Both lower limbs had no swollen.

Nervous System Examination:
          Maria Elena Ramirez was alert and her spirit was good. Her speech was clear. Her memory, orientation and calculation ability were normal. Both pupils were equal in size and round, the diameter was 3.0mms. Both eyes had sensitive reflex to light stimulus. There was no defect in both eyes’ visual field. There was no nystagmus in both eyes. The focus ability of both eyes was slightly poor. The forehead wrinkle pattern was symmetrical, the nasolabial sulcus was equal in depth, the teeth were symmetrical and the tongue was centered in the oral cavity. There was no atrophy in the tongue. The uvula was in the center. There was flexible movement in the neck. The muscle tone of all four limbs was normal; the muscle strength of both upper limbs was at level 5. The hold power of left hand was at level 5-. The hold power of right hand was at level 5. The muscle strength of both lower limbs was at level 4. The abdominal reflex was normal. The tendon reflex of both upper limbs was normal. The tendon reflex of both lower limbs was active, especially right limb. The shallow sensation between of T4 was lowered down. The tuning fork vibration sense of T8 was weaken obviously. There was obvious numbness in four limbs extremities. Right upper limb did the rotation experiment and fingers coordination examination in a stable manner. Left upper limb did the rotation experiment and fingers coordination examination in slow manner. Both sides did the finger-to-nose test in an unstable manner. Left lower limb did the coordination movement test in an unstable manner. Right lower limb did the coordination movement test in a slow manner. The Romberg's sign was positive. She had difficulty to walk in line. She was unable to stand with single leg. There was no meningeal irritation.

         We initially gave Maria Elena Ramirez a complete examination and the diagnosis was clear. The patient received treatment for nerve regeneration and to activate stem cells in vivo. She received treatment to improve her blood circulation in order to increase the blood supply to the damaged neurons and to nourish them. We also gave her daily physical rehabilitation training. 

         The balance and sports aspects: the Romberg sign has been alleviated obviously. She can stand with single leg for 3-4 seconds. The walking gait and posture are more stable than before. 

Sensation aspects:

           The numbness in four limbs’ extremities has been alleviated. The sensation in chest and trunk has slow down before the treatment, after treatment, the sensation has obviously been restored. Especially the abdomen has significant sensation. The pigmentation above the left lower limb’s inner ankle has been alleviated too. The arrhythmia of the heart has been corrected basically. Ventricular premature beat are audible 0-1times/min .The anemia has alleviated obviously.



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