Pan Li - Multiple system atrophy (Australia) Postedon October 31, 2013

Name: Pan Li
Sex: Female
Country: Australia
Age: 46
Diagnosis: Multiple system atrophy (MSA)
Admission Date: September 21, 2013
Days Admitted to Hospital: 28 days

Before Treatment:

The patient has suffered from weakness in her right lower limb without an obvious cause for the past 4 years. She could only walk by dragging her steps. She went to the hospital for anelectromyography and head CT examination, but did not receive a clear diagnosis or any therapy. The disease progressed gradually and her left lower limb also had similar symptoms. She also had difficulty maintaining her balance, and could not walk by herself. She could sit up, but rather slowly, and had difficulty turning over. Both upper limbs suffered from movement disorders and she was unable to complete thd fine motor function. Both of her hands would shake when she held an object.  Her speech was unclear. She went to Zhongshan hospital for treatment 1 year ago. The head MRI showed she had obvious cerebral atrophy and was diagnosed with multiple system atrophy. The patient received treatment for 1 month, but the outcome was not good. The symptoms progressed gradually, and her ability to move was reduced. She needed assistance from both sides, and could only drag her steps. She suffered from urinary urgency and constipation. The patient had a poor diet since the onset of disease. She took mirtazapine to control the disease. Her quality of sleep was still good. She also had urinary urgency and a bowel movement every 3-4 days. She lost weight, totalling 5Kg, in the last year.

Admission PE:

Clinostatism: Bp 123/69mmHg;Standing position: 87/62mmHg. Hr:78 /min. Temperature: 36.7 degree. The skin and mucous membrane were normal. The respiratory sounds in both lungs were clear, with no dry or moist rales. Through auscultation: the heart sound was low and dull, with no obvious murmur in the auscultatoryvalve areas. The abdomen was swollen and soft, with no obvious masses . There was no pressing pain or rebound tenderness. There was no swelling in either of her lower limbs.

Nervous System Examination:

Pan Li was alert and her speech was unclear.  Her speed was slow. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and round. The diameter of both pupils was 3.0mms and both pupils were sensitive to light stimulus. Both eyeballs could move freely. There was horizontal nystagmus in both eyes. The forehead wrinkle pattern was symmetrical. The nasolabial sulcus was equal in depth. Her teeth were symmetrical. There was no tremor in the tongue. The muscle strength of the raised soft palate was normal. She neck muscles were string enough to turn her head and shrug her shoulders. She felt dizzy when she turned her head. The muscle strength of the ulnar of her right hand was level 3. The muscle strength of both upper limbs' other parts was level 5. The muscle strength of both lower limbs was level 4. The muscle tone of the four limbs was normal. There was no muscular atrophy. She had difficulty getting up and turning around slowly. Her body would bend forward when she would stand and she could not stand by herself. Bilateral biceps reflex, radioperiosteal reflex and triceps reflex were all normal. The bilateral patellar tendon reflex, Achilles tendon reflex and abdominal reflexes were slow. The bilateral Hoffmann sign and Rossilimo sign were negative. The bilateral sucking reflex was negative. The bilateral palm jaw reflection was negative. The bilateral Babinski sign was negative. The examination of the sensory system showed no obvious abnormalities. The patient did the finger-to-nose test in an unstable manner. She did the rotation test and digital opposition test awkwardly. She did the heel-knee-shin test slowly and in an unstable manner. She was unable to stand in a stable manner whenever opening or closing her eyes during the Rombery test. She had a tendency to fall backwards. There was no sign of meningeal irritation.  The test showed she had mildanaemia.

Treatment:

After admission, the patient took the relevant examinations. The patient received nerve regeneration treatment and stem cell activating treatment. The patient received treatment to improve the blood circulation, eliminate oxygen free radicals, provide nourishment for the neurons and activate the autologous stem cells. She also received treatment to correct her anemia. This was combined with rehabilitation training. 

Post Treatment :

The patient has a better appetite. The anemia has been corrected. Her ability to swallow is better. The dizziness in her head has been alleviated. The postural hypotension is alleviated. The dizziness when she changed body positions has been slightly alleviated. The endurance of her limbs has improved. The patient can stand up from being in a seated position without any assistance. She can finish the finger-to-nose test and the rotation test of both upper limbs in a more stable manner. The horizontal nystagmus of both eyeballs has been alleviated. The sense of the urgent need to urinate has been alleviated.