Hojung Shin-Multiple System Atrophy-(Korea)

Name: Hojung Shin
Sex: Male
Nationality: Korean
Age: 53Y
Diagnosis: Multiple System Atrophy (MSA)
Discharge Date: 2018/08/05

Before treatment:
His family members found he screamed in his dreams 3 years ago. 2 years ago he had ED and he had balance problems in 2016. He also spoke slowly. He had problems with urination in March 2017, had a drunken gait and as the disease progressed he could only write slowly. He was diagnosed with MSA at a local hospital. His balance function became worse, he stood up and walked slowly and he also had orthostatic hypotension. He spoke unclearly and slowly and he had restless legs at night. He used fludrocortisone, Sinemet and Glycerol hydroxybutyrate for treatment but the effect is not good so he stopped using it. At present he feels dizzy, has dysarthria, speaks in an unclear way, has less facial expression, balance problems, a wide gait, is slow to turn around, has dysuria and heterography.
His sleep is reduced and has problems with urination and constipation.

Admission PE:
Bp: 119/83mmHg, Hr: 78/min, breathing rate: 19/min, body temperature: 36.7 degrees. His height is 170 cm, weight 80Kg. Nutrition status was good with normal physical development. There was no injury or bleeding spots of his skin and mucosa, no blausucht, no throat congestion and his tonsils did not have swelling. The respiratory sounds in both lungs were clear and there was no dry or moist rales. The heart beat was powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was flat and soft with no masses or tenderness, the liver and spleen were normal and there was no edema of the legs.

Nervous System Examination:
Patient was alert, had dysarthria, slurred and slow speech. His memory comprehension and calculation abilities were normal. He had reduced facial expression. Both pupils were equal in size and round, diameter of 2.5 mm, the reaction to light was sensitive, eyeballs can move freely and there was nystagmus. The bilateral forehead wrinkle and nasolabial fold were symmetrical, he could make his tongue extend out normally, there was no tongue muscle tremor and the tongue muscle could not move with much flexibility. The soft palate could lift powerfully, the uvula was in middle and he could turn his neck powerfully. The 4 limbs muscle power was 5 degrees and the muscle tone was normal but his 4 limbs movement coordination was weak. He could sit up or walk slowly with an unstable gait, there was a wide step and he could turn back slowly. The bilateral biceps reflex, triceps reflex and radial periosteal reflex were active. The Patellar tendon reflex was hyperactive, Achilles tendon reflex was normal, bilateral Hoffmann sign and Rossilimo sign were negative, the palm-jaw reflex were negative and the Babinski sign of both sides were negative. There was hyperesthesia of his limb endings, the other body areas sensory system examination were normal. His finger to nose test and finger opposite movement were not stable, the fast alternate movement was clumsy, he could perform the heel-knee-tibia test but not stable and the Romberg sign was negative. He could not stand with a single leg, the meningeal irritation sign was negative.

Treatment:
After the admission he received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair his damaged nerves, replace dead nerves, nourish nerves, regulate his immune system and improve blood circulation. This was combined with rehabilitation training.     

Post-treatment:
After 14 days treatment his dizziness reduced, the blood pressure change from lying posture to standing position reduced, it was now 120/80mmHg in lying posture, 100/60mmHg in standing position. His endurance improved, balance control was much better, he could walk with a much more stable gait and he could now stand with a single leg. His hand coordination got more stable, especially his fast alternate movement which was much more flexible. His standing with eyes closed was much more stable and he could now stand on his right leg for 10 seconds and on his left leg for 3 seconds.

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