Muhammad - Parkinson syndrome (Pakistan) Posted on April 5, 2013

Name: Muhammad Ahmad Qureshi          

Sex: Male

Country: Pakistan

Age: 60

Diagnoses: 1. Parkinson syndrome 2. Hypertension level 2  3. Plasma hyperhomocysteinemia

Admission Date: 2013-02-25

Days Admitted to Hospital: 28 days

Before treatment:

The patient suffered from flexion and pain in the right toe in August 2006. He also suffered from rigidity below the knee. After walk for 20 minutes, the symptom was alleviated. He went to a local hospital and the masked face was founded. He was diagnosed with Parkinson disease. After the patient took Sinemet, the symptom was alleviated. The disease progress gradually. The patient suffered from static tremor, pain, weakness and rigidity of the right lower limb in 2007. The patient's left lower limbs suffered the same symptom in 2008. The doctors in the local hospital increased the dose of Sinemet for treatment. But the disease progressed gradually. The patient also started with micrographia 5 years ago. The patient started with speech disorder and salivation 2 years ago. The tremor and rigidity of both lower limbs were aggravated. He also had difficulty with walking. Both lower limbs felt pain and sometimes he fell down. The local doctor increased the dose of medication, but the effect was not good. The patient still had tremors and rigidity of both lower limbs. He couldn't turn over in a recumbent position. He couldn't stand up from a sitting position. This was accompanied with dysgraphia, salivation, sleep disorder and speech disorder.

Nervous System Examination:

The patient was alert. He had a speech disorder and the speech was unclear. The speech was uncontrollable. He also had salivation. The memory, calculation ability and orientation were normal. He had micrographia and facial masking. Both pupils were equal in size and round, the diameter was about 3.0mms. Both pupils were sensitive to light stimuli. Both eyeballs had difficulty looking up, and his eyes had a convergence defect. The movement of both eyeballs were sensitive to looking down and to the left or right side. There was no obvious nystagmus. The forehead wrinkle pattern was symmetrical. The nasolabial groove was symmetrical. The tongue was centered in the oral cavity. There were no tremors in the genioglossus. The raising ability of the soft palate was almost normal. The uvula was shifted to the right side. He could turn his head flexibly. The shrug muscle strength of the shoulders was strong. The muscle strength of the four limbs was level 5. There were static tremors in both lower limbs and the right side was more severe. He had difficulty with sitting up or standing up. He had difficulty with starting to walk and presented a slight festinating gait. The trunk was obviously bent to the right side when he walked. The walk was unstable when he walked in a straight line and had a tendency to fall down frequently on the right side. The muscle tone of the left toes was higher than normal. The muscle tone of the four limbs was almost normal. Bilateral biceps reflex, triceps reflex, radioperiosteal reflex, patellar tendon reflex, Achilles tendon reflex and abdominal reflexes were normal. Bilateral Hoffmann sign was negative. Bilateral Rossilomo sign was negative. Bilateral sucking reflex was negative. Bilateral Palm jaw reflex was negative. Bilateral Babinski sign was negative. The hypalgesia in both upper limbs and the right lower limb was slowed down. The deep sensation, shallow sensation and fine sensation in the body were normal. Both sides of the body were able to finish the finger-to-nose test and digit opposition test in a stable manner. He did the rapid rotation test in a clumsy manner. Both sides of the body did the heel-knee-shin test in a stable manner. Both sides of the body were able to finish the heel-knee-tibia test in a stable manner. The Romberg's sign was positive (when we push the patient forward, he had a tendency to fall). There were no signs of meningeal irritation.

Treatment:

The patient received all of the relevant examinations and was diagnosed with Parkinson syndrome. He received treatment to expand blood vessels to increase the blood-supply, nerve repair, nerve regeneration and he was given nerve nutrition. He, also, received treatment for antiparkinson, to protect gastric mucosa and get rid of the oxygen free radicals in the brain. This was combined with physical rehabilitation training.

Post-treatment:

The patient's blood pressure is under control. He has better sleep. His speech is clearer than before. The salivation was not severe. The writing is clearer than before. The uvula is in the center of the oral cavity. His dosage of Sinemet was reduced from 1375 mg to 1000 mg every day. The static tremors of both lower limbs is obviously alleviated. He can do the action of sit ups and stands more quickly. There is no difficulty with starting when he does exercises. He walks stably when he walks in a straight line. He can turn round quickly and there was no tendency to fall. The muscle tone of the four limbs is almost normal. The deep sensation and shallow sensation examination of the four limbs was normal. The fine sensation of the four limbs was normal too. Both sides of the body were able to finish the finger-to-nose test and digit opposition test in a stable manner. He does the rapid rotation test in a flexible manner. Both side of the body did the heel-knee-shin test in a stable manner. The Romberg's sign was negative. The homocysteine is restored to a normal level.


The second round therapy:

Diagnoses: 1. Parkinson syndrome 2. Hypertension level 2 

Admission Date: 2013-10-21

Days Admitted to Hospital: 28 days

The patient's condition has shown clear progress after the first treatment. The tremor has alleviated. The writing is clearer than before. He can turn round quickly. He took medication for six months after discharge. Then the patient came to our hospital for further treatment.

Admission PE:

Bp: 160/95mmHg; Hr: 78/min. Br: 19/min. Temperature: 36.1 degree. The head was lean to right side. Trunk was bent to right side. The walking posture and gait was abnormal. The nutrition was normal. The skin and mucosa was intact, with no stained yellow or petechia. There was no congestion in the pharyngeal. The tonsil was not enlarged. The respiration in both lungs was clear, no dry or moist rales. Through auscultation, it was determined that the heart sounds was low, with no obvious murmur in auscultatory valve areas. The abdomen was soft and even, with no pressing pain or rebound tenderness.  There was no mass in abdomen. Doctor didn't touch the liver and spleen under rib. There was swelling in the lower ankles. The HCY result was higher than normal.

Nervous System Examination:

Muhammad Ahmad Qureshi was alert. He had speech disorder and vague pronunciation. He was salivating too much. His memory, calculation abilities, and orientation were normal. He had masked face and micrographia. Both pupils were equal in size and round, the diameter was about 3.0mm. Both pupils were sensitive to light stimulus. Both eyeballs had difficulty with look upward. The convergence ability was poor. Both eyeballs could move to other side freely, with no obvious nystagmus. He could blink eyes quickly and flexibly. The forehead wrinkle pattern and bilateral nasolabial grooves were symmetrical. The tongue was centered and there were no obvious tremors in the tongue muscles. The muscles that raise the soft palate were strong. The uvula had deflection to right side. He had strong muscle to turn head and shrug the shoulders. The muscle strength of four limbs was level 5. There was no obvious tremor in four limbs. He had difficulty with turning over and sit-up. He always leans to right side unconsciously when he was in seat position. This was more severe when he had diet. He had ache in right leg and ache in waist. There was no pressing pain. He could stand up and sit down quickly. There was difficulty when he started to walk. His walking speed was slow than others. He walked unstable when he walks in straight line. Sometimes, he had festinating gait. He turns around rapidly and often had tendency to fall down. The muscle tone of four limbs was almost normal. Bilateral biceps reflex, triceps reflex, radioperiosteal reflex, patellar tendon reflex, abdominal reflexes and Achilles tendon reflex were normal.  Bilateral Hoffmann sign was negative. Bilateral Rossilomo sign was negative. Bilateral sucking reflex was negative. Bilateral palm jaw reflex was negative. Bilateral Babinski sign was negative. The patient had normal deep sensation, shallow sensation and fine sensation. He both side done finger-nose-test and digital opposition test in a stable manner. He did both sides rapid rotation test in a clumsy manner. He did the heel-knee-tibia test in a stable manner. The Romberg sign was negative. He couldn't stand with single leg. The meningeal irritation was negative. MRI of head: there was no obvious abnormality.

Treatment:

Muhammad Ahmad Qureshi received treatment from October 21, 2013. The patient received nerve regeneration treatment and stem cell activating treatment. Then he received anti-Parkinson's treatment and anti-free radical treatment. He was also given treatment in order to expand the blood vessels to improve the blood-supply to the damaged brain, nourishment for the neurons and protect gastric mucosa. This was combined with physical rehabilitation training.

Post-Treatment:

Muhammad Ahmad Qureshi starting difficulty has reduced. The festinating gait has alleviated. The right-leaning has alleviated slightly. The salivation is reduced than before. His speech is clear than before. His both side do rapid rotation test in a flexible manner. He focuses attention better now. He can stand a longer time with single foot. The blood pressure is under control. The HCY level has reduced to normal level.
 

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