Alhazmi Abdulrahman Ibrahim-Multiple Sclerosis-(Saudi Arabia)

Name: Alhazmi Abdulrahman Ibrahim 
Sex: Male
Nationality: Saudi Arabian
Age: 25Y
Diagnosis: Multiple Sclerosis(MS)

Before treatment:
In 2008 the patient felt stiffness in both legs and his left arm. He didn’t go to hospital and all of the symptoms went away. After that he began to have balance problems so he went to hospital in 2009 and did some tests and was diagnosed with MS. He undertook some type of treatment and felt better but in the next 6 years his disease relapsed and remitted over and over. He had bad vision functions, abnormal feeling, balance problems, motor problems and gatism. His problems recurred 2 years ago and this time it was very serious as he couldn’t walk and couldn’t control his defecation or urination. He used Tgsabri to treat his condition and  became better but he still needed a stick to help him walk. For now, he is able to turn over, sit up and stand, but his legs are weak and he walks slowly. He wants a better life so he came to our hospital.
His spirit is good, his appetite, sleep and weight are normal. Sometimes, it is hard for him to urinate or defecate.

Admission PE:
Bp: 103/72mmHg, Hr: 68/min, body temperature: 36.7 degrees. Height: 169cms, weight: 56kgs. His physical condition was normal but his body is thin. The skin and mucosa were normal, with no yellow stains or petechia. Oropharynx was not congestive and the bony thorax was symmetrical. The respiratory sounds in both lungs were normal and there was no dry or moist rales. The heart sounds were strong and the cardiac rhythm was regular with no obvious murmur in the valves. The abdomen was flat and soft, with no masses or tenderness. His liver and spleen were normal. Shifting dullness was negative. Spinal column was normal. There was no edema in either leg, his anus and external genitalia were not examined.

Nervous System Examination:
He was alert and his spirit was good but his speech was unclear. His memory, orientation and calculation ability were normal. Both pupils were equal in size and round, the diameter was 3mm. Both pupils were insensitive to light stimulus. There was diplopia when he stared to the right. Both eye fields were normal. He didn’t have nystagmus. The forehead wrinkles were symmetrical.and bilateral nasolabial sulcus was equal in depth. His mouth and teeth were in the right position without deflexion. His tongue was centered in his mouth, his tongue muscle was normal, uvula was centered in his mouth. His neck moved freely, shrug shoulders power was strong, the muscle tension of his four limbs was normal. The muscle power of the arms was normal, the muscle power of the legs was at level 4. The tendon reflex of the right arm and legs was active, the left arm tendon reflex was weak. The abdominal reflexes were elicited. His palm jaw reflex was negative, bilateral Hoffmann and Babinski sign were positive. Bilateral ankle clonus was negative. His body deep and superficial feeling were normal. Bilateral finger to nose test was not performed well, bilateral rapid rotation test and finger to finger test were clumsy. Bilateral heel-knee-tibia test were not done well. His body leaned forward slightly when he was standing. He was able to stand on both legs but  he was unable to stand on one leg. Romberg sign was positive and the meningeal irritation sign was negative.

After the admission, he received related examinations and was diagnosed with multiple sclerosis so he received treatment to nourish nerves and improve blood circulation. He also had rehabilitation training.

After 14 days treatment his balance function was better than before, bilateral finger to finger test improved and his walking posture was slightly better. He was able to stand on one leg for ten seconds.



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