Mr.Kim-Multiple System Atrophy-(Korea)

Name: Mr.Kim
Sex: Male
Nationality: Korean
Age: 62Y
Diagnosis: Multiple System Atrophy(MSA)     
Discharge Date: 2019/01/26

Before treatment:
The patient felt dizzy and had tinnitus 14 years ago. He couldn’t stand on one leg and sometimes he fell down when he walked. He walked slowly and spoke unclearly. He went to hospital in 2012 and was diagnosed with MSA. His disease slowly progressed. 1 year ago he didn’t know if he wanted to urinate or defecate and he had uroschesis so he used disposable catheters for urination. Six months ago he had pyelonephritis and his MSA got worse rapidly, he was unable to walk 4 months ago, 3 months ago he had problems with swallowing, he choked when drinking and he had a lot of saliva. At present he has balance problems, orthostatic hypotension, he can’t walk and he speaks unclearly. His memory function is bad, he chokes when drinking and  he has problems with urination and defecation.
He eats well and sleep well. He uses catheters for urination and medicines for defecation. He has lost 25kg in weight.

Admission PE:
Bp: 132/86mmHg, Hr: 68/min, breathing rate: 18/min, body temperature: 36 degrees. Height 182cm, weight 61Kg. Nutrition status is good with normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht and no tonsil swelling. The chest development is normal, chest movement was basically normal, breathing sounds of both lungs were clear and there were no obvious dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was soft with no mass 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 and a low voice. He had normal comprehension ability, the short memory and calculation were not good enough. Both pupils were equal in size and round, diameter of 2.5 mm, react well to light, the eyeballs can move freely and no nystagmus. Bilateral forehead wrinkle and nasolabial fold are symmetrical, he could make his tongue extend out normally, there was no tongue muscle tremor, the tongue could not move flexibly and the soft palate could lift powerfully. The doctors did not see the uvula. He could turn his neck powerfully, muscle power of the 4 limbs was 5- degrees, leg muscle power was 4 degrees and there was normal muscle tone. Bilateral biceps reflex, triceps reflex and radial periosteal reflex were active, the patellar tendon reflex and Achilles tendon reflex were normal, Bilateral Hoffmann sign and the Rossilimo sign of both sides were all negative. The Palm-jaw reflex of both sides and the Babinski sign were negative. His left side superficial sensory was decreased, both sides fine motor sensory were normal. Finger opposite movement was normal, the fast alternate movement and finger to nose test were not good, the heel-knee-tibia test was not stable or accurate, the Romberg's sign was positive and the meningeal irritation sign was negative.

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.     

After 14 days treatment his dizziness was better, he spoke clearer and his swallowing function was better. His appetite got better, there was less choking when drinking, the hands tremor reduced and he could perform the coordinate movements with much more flexibility. He showed a better balance function,  could stand on his left leg for 5s, on the right leg for 8s and he walked better. The blood pressure change from lying posture to standing position decreased with the lying position: 135/85 mmHg and standing position: 115/70 mmHg.


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