Ms. Khames-Multiple Sclerosis-(Yemen)

Name: Ms. Khames 
Sex: Female
Nationality: Yemenese
Age: 42Y
Diagnosis: Multiple Sclerosis(MS)

Before treatment:
The patient was unable to see clearly with her left eye 17 years ago and sometimes there was diplopia. She went to a local hospital and did an MRI test. The results showed demyelination changes and she was diagnosed with MS. She was prescribed interferon injections once a week for 2 years. In the first year she felt better but in the second year she felt no change so the treatment was stopped. She also took dimethyl fumarate for 3 months and had natalizumab  injections once a month for 8 months but there was no good effect. She then had limb weakness and balance problems 7 years ago and her condition got worse and worse. At present she is unable to see clearly with her left eye, there is diplopia, her limbs are weak, she can walk with help but she has balance problems. Her right fingers are numb and she feels pain in the left side of her back  when she is walking.
Her spirit is good, her sleep and diet are normal. Her defecation function is normal but sometimes she has urge incontinence.

Admission PE:
Bp: 114/70mmHg, Hr: 76/min, body temperature: 36.8 degrees. Height 163cm, weight: 57Kg. Nutrition status is good with normal physical development. There are no broken or bleeding spots of her skin and mucosa, no congestion of the throat, no tonsil swelling, the chest development was normal, the respiratory sounds in both lungs were clear and there were no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was bulging and soft with no masses or tenderness. Liver and spleen were normal, shifting dullness was negative, spinal column physiological curvature was normal and there was no edema of the legs.

Nervous System Examination:
Patient was alert and had clear speech. Her orientation and calculation abilities were normal but memory was not very good. Both pupils were equal and round, diameter of 3.0mm, react well to light, had no visual field loss and no nystagmus. Bilateral forehead wrinkle and nasolabial fold are symmetrical. Showing the teeth was normal, she could make her tongue extend out normally, there was no tongue muscle atrophy and the uvula was in the middle. Her neck can move freely, she can turn head and shrug as normal. The left arm muscle power was 4 degrees, right arm muscle power was 5- degrees. Leg muscle power were both 3- degrees. The muscle tone of the four limbs were normal and the tendon reflex of all four was active. Bilateral Hoffmann sign, Rossilimo sign and Babinski sign were positive. The ankle clonus of both sides were negative. Left finger skin pinprick sensation was reduced, other sensory examinations were normal. The finger to nose test and finger opposite movement were normal. The patient can perform fast alternate movement but in a clumsy manner. The heel-knee-tibia test was not stable or accurate, she can stand on just her right leg for 2 seconds and for 3 seconds on the left leg.  The Romberg's sign test was not good, the meningeal irritation sign was negative.

After the admission she received related examinations and received 3 times nerve regeneration treatment to repair her damaged nerves, replace dead nerves, nourish nerves, regulate the immune system and improve blood circulation. This was done with rehabilitation training.     

After 14 days treatment the patient had more energy and did not feel tired as easily. The fast alternate movement test using the arms was improved.

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