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Constantina - MND (Jordan) Posted on November 3, 2014

Author Tracy Views Posted at 2014/11/03

Name: Constantina Toma Alexandru Vasile 
Sex: Female
Age: 53
Nationality:Jordan
Diagnosis:Motor neuron disease
Admission Date:2014-10-17
Treatment time:14 days

Before treatment: The patient fell down when she was skiing on January, 2013. And got meniscus injury of her right knee joint. The patient felt her right limbs were too painful to walk, she got an extremely slow improvement during the subsequent rehabilitation training and failed to walk as normal. And then her condition developed gradually,showed weakness of her left lower limb and both upper limbs, limbs movement disorder with muscular atrophy and fasciculation, as the condition gradually worsened, the patient started to appear bucking when she drank, difficulties in swallowing and speech, dysarthria. The patient's electromyography examination showed neurogenic damage on October, 2013 and diagnosed as Motor Neuron Disease. Oral medication(Riluzole)did not work well. The patient's condition and speech disorder worsened obviously, nearly all language could not be understood; difficulties in chewing and swallowing, and liquid diet through mouth only. Now,the patient cannot speak, salivate, have difficulty in breathing, the patient cannot take care of herself in her life due to limbs weakness and muscular atrophy, hard to turn over and cannot sit - up when she is in lying position, cannot finish washing,wearing and eating.

Since the onset of the disease, the patient's mentality has been good, lost weight, liquid diet through mouth, normal sleep, urine frequently, and stool one time every two to three days.
 

Admission PE: Bp: 129/88mmHg; Hr: 86/min, temperature 36.0 deg. Her skin and mucosa have no yellow stains or petechia. There was no congestion in pharynx. The tonsil was not enlarged. The thorax was symmetrical. There was no malformation. The degree of thorax mobility was reduced when she took a breath. The degree of thorax mobility was reduced obviously when she took a deep breath. The respiratory sounds in both upper lungs were clear, the respiratory sounds in both lower lungs were weak. There was no obvious moist or dry rales. The rhythm of her heartbeat was normal, with no obvious murmur in the valves. Her abdomen was flat and soft, with no pressing pain or rebound tenderness in the abdomen. There was no edema in both lower limbs and no enlargement of liver and spleen.

Nervous System Examination: Constantina was alert and her spirit was good. Her memory, calculation abilities and orientation were all 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 forehead wrinkle pattern was symmetrical. She was able to close her eyes with ease. The bilateral nasolabial sulcus was equal in depth. She was unable to stretch tongue. There was atrophy in tongue. There was obvious fibrillation. The teeth were shown without deflection. She was unable to drum her cheeks. She had weak muscle to raise her soft palates. The pharyngeal reflex was weak. She had too much salivation. She coughs when she drinks water. There was swallow difficulty. She had weak muscle to chew and cough. She had dysarthria and the speech was unclear. The muscle strength of neck was normal and she could support her head normally. She had weak muscles to turn her neck. She was unable to shrug her shoulders. The muscle strength of both four limbs between level 0-1. Only the feet had slight movement. The muscle tone of four limbs was increased. There was obvious muscle atrophy in bilateral shoulder girdle, upper limb muscles, bilateral thenar muscle and bilateral (hand) muscles of fingers. The abdominal reflexes were normal. Bilateral Babinski sign was neutral. The deep sensation and shallow sensation, using primary measures, were normal. She was unable to finish the finger-to-nose test, the heel- knee - shin test or finger coordinate movement test. There were no signs of meningeal irritation. The oxygen saturation was 90-92%.

Treatment: We initially gave Constantina a complete examination and she was diagnosed with motor neuron disease. She received treatment to activate or launch her neuro recovery and nerve regeneration, activate her own stem cells, improve her blood circulation, trophic nerve and neural restoration by medications. At the same time, she received non-invasive ventilator for breath. This was accompanied with daily physical rehabilitation training.

Post treatment: There is no further deterioration of patient's condition after two weeks treatment. Her endurance and the movement of mouth pharynx and throat have improved. The patient can drum cheeks better than before. She can stretch tongue better and the tongue can come out of the lips. The salivation has reduced. The patient's respiratory function has improved. Bilateral breathing activity has increased. The oxygen saturation has improved and reached 95%.

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