Alana Amnah Hussain-Parkinson-(Saudi Arabia)

Name: Alana Amnah Hussain                     
Sex: female
Country: Saudi Arabia
Age: 65
Diagnoses: 1.Parkinson disease 2.hypertension level 2 (very high risk)
3. Hyperlipidemia
Admission Date: 2011-09-06

Medical History:
Alana Amnah Hussain is a 65 year old female. She has had tremors in the right arm beginning 10 years ago without a known cause. She also had slight difficulty with her balance. Soon after, tremors developed in the left arm as well as well as bradykinesia. Alana received treatment 8 years ago and the doctors considered Parkinson disease. About 5 years ago, her speech became slurred and both the arms and legs became stiff and weak. The symptoms gradually became worse and she was later given a clear diagnosis of Parkinson disease. She received appropriate medication for treatment with good results. The symptoms including abnormal posture and gait, bradykinesia, and unstable walking was alleviated with anti-Parkinson medication. In recent years the symptoms had been gradually aggravated and Alana developed back pain and was unable to stand. As a result she had to remain in bed most of the time. After taking her medication she was able to turn over in bed, drink and eat unassisted, but in general she was unable to take care of herself.

Nervous System Examination:
Alana was alert, but her speech was not clear. Her facial expressions were limited. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and round, the diameter was about 2.5mms. The movement of both eyeballs was flexible and both pupils were sensitive to light stimuli. The forehead wrinkle pattern and nasolabial groove were symmetrical. She had to breathe with her mouth open. The teeth were shown without deflection and the tongue was centered in the oral cavity. There were tremors in the muscles of the tongue. She had difficulty with swallowing and would cough when she drank water. The muscles that raise the soft palate were weak. The body had weak turning ability and the muscle strength was weak. The shoulder muscles had weak shrugging ability. The muscle strength of the upper limbs was level 4. The grasping strength of both hands was level 4. The muscle strength of the lower limbs was level 2+. The muscle tone of all four limbs was normal. Alana was unable to stand or walk. There was difficulty with starting her movements and the movements were slow. The fine motor skills of the hands were poor. The tendon reflexes of all four limbs were not elicited. The bilateral Hoffmann's sign was positive. The bilateral palm jaw reflex was positive. The sucking reflex was positive. The bilateral Babinski's sign was negative. There was almost normal fine, deep, and shallow sensation. The bilateral finger-to-nose test was not stable. She was able to complete the rapid rotation test and the digital opposition test slowly. She couldn't complete the heel-knee-shin test, and she couldn't cooperate with the Romberg's test (for she couldn't stand by herself).

From the onset of the Parkinson disease, Alana had poor sleep quality, talked in her sleep, and maintained a poor diet. She would eat very little. There was no significant change in her bodyweight.

Treatment:
Alana received all of the relevant examinations. She was diagnosed with 1.Parkinson disease 2.hypertension level 2 (very high risk) 3. Hyperlipidemia. She received anti-Parkinson's treatment and had the oxygen free radicals eliminated. She was also given treatment in order to expand the blood vessels, nourishment for the neurons and control the blood pressure. This was combined with physical rehabilitation training and language training. 

Post-Treatment:
Alana Amnah Hussain's condition has improved. Her mental outlook is better than before. The treatment adherence is better than before. The sleep time is more regular. The abdominal distension has been almost completely alleviated. The bowel movements are regular. The starting difficulty is not as server. The reactions are quicker than before. The speech is clearer than before. The eating ability is better and there is no more upset stomach. The swallowing difficulty has been alleviated. The facial expressions are now more natural. The tremors in the tongue and in both upper limbs have been alleviated. The slow actions of getting up, turning over, sitting up, walking and changing directions have become quicker than before. The fine movements of the fingers are more flexible. The muscle strength of the lower limbs has increased, and has reached level 4-. She can walk several meters without support, and the distance of the strides has increased. The posture and gait abnormality has disappeared. She still needs some assistance when walking through a narrow place. The balancing ability has improved noticeably. Alana is satisfied with the treatment effect and say thanks to all the staffs of our medical center.

After discharge, her daughter emailed to us:

2011-10-07

My mother started to walk without assitance for longer distance and her back is better, mostly she can walk with straight back. Her hands most of the time do not shake but if she does some effort or if she is in a deep thinking her hands shack but most of the time she can control them.

She did not change much in the sleep but two days ago she slept for more than 10 hours.

Her breathing is much better but still at eraly morning and late evening also while she is sleeping she breath from the mouth. Her appetit is good. The memory she can remember better than the last injection. And she can solve some math (last test out of 5 she got 5). Also the speech is better.
Thank you for your effort
Best regard,
Murtadha

2011-10-26

 My mother only had 3 times fall down in recent two weeks. With thesticks, she walk in good form every time, except ( before and dring and after sleep). Her memory is better than before. She only had tow times nightmares in 10 days, this is good improvements. She has almost stoped dreaming while she is awake. The muscle strength is stronger than before. She can stand up from the ground for more than 4 times.

2011-11-29

She can walk with long steps better than before. She just need to feel protected just by catching her hand.  She can stand and walk with better bending almost straight. The tremors almost stopped unless we let her try to do something by herself. She sleep much better than before. The breaths is good but she still prefer to use her mouth instead of her nose and when she trying to do some exercises she breath very fast before doing any thing. Standing srom the ground and walking with long steps and getting out of the bed and having shower. Fer two days, she stopped having urine at midnight. But sadly she turned back to have one or two times at midnight. She has much less nightmares than before. She has good muscle strength, but she needs to increase power of the lower lumb.

2012-10-07

Dear Doctor,

It has been long time since the last e-mail. Here I will just report to you the improvement of my mother status.

lately she started to work harder and doing more activity and I notice that the balance improvement and she started to be independent in some activity but the walking gate still there some difficulty in raising the right leg from the ground it looks like drag the ground. Moreover, after our visit to the psychiatrist with taking the medicines related to depression we notice that the depression totally disappeared so now she stopped the dosage for three months and she is doing well.right now she is still has problem with the urea specially at night and the sleeping disorder. Next time I will attach the blood pressure measurements. and if you need any tests please tell me.

Best regards,
Murtadha AlBahrani