Sunny Peries - Amyotrophic lateral sclerosis The patient suffered from weakness in her right hand in July 2012 without an obvious cause. She couldnt open a bottle by herself. The disease progressed quickly in October 2012, the weakness of her right hand was obvious. She was unable to finish fastening a button or drinking water from a cup. Her whole body felt tired. She had obvious muscle tremors of the right upper limb in December 2012. She went to a local hospital many times from October 2012 to December 2012. She received a head MRI and EMG examination in a local hospital. The result showed she suffered from slow nerve conductive velocity. So she was diagnosed with ALS. It was suggested that the patient go to Europe for further therapy. The patient went to a hospital in Europe and received EMG and nuclear magnetism examination. The result of nuclear magnetism showed she had cortico-striato-spinal degeneration and slow nerve conductive velocity. So the patient was diagnosed with ALS. She didnt received special treatment. The disease worsened in March 2013. She had weakness in the left hand, and tremor of the four limbs and muscles in the abdomen. She, also, had slow speech. So she went to a hospital in Beijing and received rehabilitation training. The muscle tremor was reduced more than before. Before the treatment, the patient had weakness of the four limbs and the upper limbs were more severe. She also had glossolalia, slow speech and a mild swallowing difficulty. Nervous System Examination: Sunny Peries was alert and her mental faculties were good. The voice was low and weak, the pronunciation was unclear and the speed was slowed down obviously. Her memory, calculation abilities and orientation were normal. Both pupils were equal in size, the diameter was 3mms. Both eyeballs could move flexibly and the pupils reacted normally to light stimulus. The convergence ability of both eyes was poor. The forehead wrinkle pattern was symmetrical. She had strong eye closing ability. The bilateral nasolabial sulcus was equal in depth. The tongue was centered in the middle of the oral cavity. There was fibrillation in the lingualis. There was mild muscle atrophy in the tip of the tongue and there was atrophy in the body of the tongue. There was no deflection when she showed the teeth. There was air leakage when the cheeks were expanded. She had a slight swallowing difficulty. There was a cough occasionally when she drinks. She needed 30 minutes to eat breakfast. There was muscle atrophy in the bilateral supraspinatus muscle, infraspinous muscle, deltoid, triceps muscle of arm, musculus biceps brachii, forearm muscles groups, interosseus, big or small thenar muscles. The thrust force of the right upper arm and the outreach strength of upper limbs was level 3. The muscle strength of the right upper limb and right lower limb was level 4-. The muscle strength of the left upper limb and left lower limb was level 5-. All the fingers in both hands had an obstacle to stretching. The muscle tone of both upper limbs was reduced. The muscle tone of both lower limbs was normal. The deep and shallow sensation of both sides was normal through loose measure. The tendon reflex of the four limbs was active. The abdominal reflexes were normal. Bilateral palm jaw reflex and Hoffmann sign were positive. The Rossilimo sign was positive. Bilateral Babinski sign was positive. Jenny Peries was able to finish the rapid rotation test and digital opposition test, but in a clumsy manner. The right hand was clumsy, the right thumb couldnt point to the right little finger. She did the finger-to-nose-test in an unstable manner and did the heel-knee-shin test in a clumsy manner. She had poor backward balance ability when she did the Romberg sign test. There were no signs of meningeal irritation. Treatment: We initially gave Sunny Peries a complete examination, and she was diagnosed with amyotrophic lateral sclerosis. She received treatment to improve her blood circulation in order to increase the blood supply to the damaged neurons, to repair the damage to the neurons and to nourish them. She also received treatment to improve the immunity of the organism. She used a non-invasive ventilator for breathing. This was accompanied with daily physical rehabilitation training. Post treatment: The PE at admission showed the protein level was lower than normal. She was diagnosed with hypoproteinemia. After the symptomatic treatment and strengthening nutrition, the protein level was restored to a normal level. According to the results of the thyroid gland 5 items showed the T3 and T4 were higher than normal. The heart rate range was between 95-105. She had hyperthyroidism. She received methimazole, than the thyroid function was restored to normal. At present, the patients condition is better than before. She speaks more clearly. The voice is louder than before. The weight has increased by 2Kg. There is no atrophy in the tongue and there is no tremor in the tongue. There was no air leakage when the cheeks were expanded. There is no difficulty swallowing, no cough when drinking. She needs 10 minutes to have breakfast. The muscle in both the interosseus, big or small thenar muscles has increased. The muscle strength of the left limbs is level 5. The thrust force of the right upper arm and the outreach strength of upper limbs was level 4. The muscle strength of the right upper limb and right lower limb is level 5-. The fingers in both hands can stretch better. She is able to do the rapid rotation test and digital opposition test more flexibly. She does the finger-to-nose-test in a more stable manner. She also does the heel-knee-shin test in a more stable manner. At present, the patients condition is stable. wumedicalcenter/article/PatientStories/als/3020131213540.html
Posted on: Thu, 17 Jul 2014 01:01:13 +0000
Trending Topics
Recently Viewed Topics
© 2015