Ali - Spinal cord injury (Qatar) Posted on March 10, 2014

Name: Ali Nawaz Amna
Sex: Female
Age: 11 years old
Country: Qatar
Diagnosis: Spinal cord injury
Admission Date: 2014-02-07
Days Admitted to the Hospital:14

The patient suffered from car accident about 4 and half years ago. So the patient suffered from sensory disorder and movement disorder. She was sent to local hospital and was diagnosed with Spinal cord injury, rib fracture, hemopneumothorax liver injury. She received operation for treatment. After operation, the patient received rehabilitation. The patient received stem cells therapy in Beijing Puhua International Hospital 1 years ago and 2 years later. After treatment, the patient could perceive urine and defecation partly. Her lower limb joints were somehow restored topesthesia. Before the treatment, the patient's lower limbs still had no autonomic activities. With the support of arms, the patient could support sit-up. For further treatment, the patient came to our hospital and was diagnosed with spinal cord injury.

From the onset of disease, the patient had good spirit. Her sleep was regular. She had constipation and defecation every 2-3 days. She didn’t need drugs enema. She also suffered from urinary incontinence and catheterized intermittently. She had 4 times catheterization each day. Her weight had no abnormal change.

Admission PE:
Bp: 124/89mmHg; Hr: 59/min. Temperature: 36.5 degrees. Br: 19/min. She was overweight. The skin and mucosa were normal, with no ecchymosis, petechia or yellow stains. There was no bedsore in her body. There was a surgery scars at the center of the neck and back and the scar was about 20cm. The scar was from an operation which has healed well, with no ulceration. There was a rupture in her right labia minora inner side, size was about 1cm*2cm. The rupture was congested, with no purulent secretion. There was congestion in the pharyngeal. There was no enlargement of the tonsils. The thorax was symmetrical. The respiratory sounds in both lungs were clear, with no dry or moist rales. The cardiac rate was normal and the heart sound was strong. The heart rate was 59/min. There was no obvious murmur in auscultatory valve areas. The abdomen was soft and smooth, with no obvious masses. There was also no pressing pain or rebound tenderness. We were unable to touch the liver or spleen under the rib. The borborygmus was present normally through auscultation. There was abnormal kyphosis of vertebral column. The temperature and color of both heels were normal. The dorsal artery of the acrotarsium was beating strongly. 

Nervous System Examination:
Amana Ali Nawaz was alert. Her speech was fluent. Her memory, calculation and orientation abilities were normal. The pupils were equal in size, the diameter was 3.0 mm and the pupils reacted normally to light stimulus. Both pupils move freely. The forehead wrinkle pattern was symmetrical. The tongue was centered in the oral cavity and the teeth were shown without deflection. Her neck could move flexibly. She could shrug her shoulders normally. The muscle tone of both upper limbs was normal. The muscle tone of both lower limbs was higher than normal. The muscle strength of both upper limbs was at level 5, the muscle strength of both lower limbs was at level 0. The tendon reflex of both upper limbs was normal. Bilateral lower abdominal reflexes were not elicited normally. The patellar tendon reflex and Achilles tendon reflex of both lower limbs were negative. The shallow sensation from T2 to T6 was slow down. The shallow sensation below T6 disappeared. There was zonesthesia in T2 to T10. The deep and shallow sensation in T2 to T10 was slow down. The deep sensation below T10 disappeared. Bilateral Hoffmann sign and Rossilimo sign were negative. Bilateral palm jaw reflex was negative. Bilateral Babinski sign was positive. Bilateral ankle clonus was positive. The coordinate movement examination of both upper limbs was normal. The patient was unable to finish coordinate movement examination of both lower limbs.  MRI of spinal cord: contusion of spinal cord from C7 to T2.

Treatment:
We initially gave Ali Nawaz Amna a complete medical examination. We proceeded with the nerve nutrition. We improved the blood circulation to increase the blood supply to the damaged neurons. He also received nerve cell activation treatment and nerve regeneration. This was combined with daily physical rehabilitation training.

Post-treatment:
The patient's motor function has improved. The muscle strength of the patient's lower limbs is at level 1 now. The clonus of both lower limbs has been alleviated. There is specific muscle contraction. He can stand with support. Bilateral abdominal reflexes can be elicited. His sensory system has improved obviously. The deep and shallow sensation plan all have enlarged. The shallow sensation above T10 existed normally. The deep sensation and shallow sensation below T11 has slow down. Bilateral Babinski sign is changed from positive to negative.