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Anita Stojanovska - Amyotrophic lateral sclerosis (Macedonia) Posted on July 20, 2012

Author Julia Views Posted at 2014/01/14

Name: Anita Stojanovska
Sex: Female
Country: Macedonia
Age: 43
Diagnoses: ALS (Amyotrophic lateral sclerosis), low pigment-small-cell anemia
Admission Date: 2012-04-03
Days Admitted to Hospital: 28

Anita underwent lower abdominal surgery about 3 years ago. Four months later, the movements of the tongue began to slow down. She also developed speech problems, swallowing difficulty and would sometimes choke while drinking. The right hand had difficulty grasping objects. Six months later, weakness developed in the right leg, left arm and left leg. Two years ago, Anita was diagnosed with amyotrophic lateral sclerosis. The symptoms gradually progressed. The weakness in the limbs became worse and the weakness started spreading from the neck to the torso. The speech problems and swallowing difficulty got more severe. There were no medications prescribed at that time. At the time Anita was admitted to our medical center her symptoms included speech problems and swallowing difficulty as well as muscle atrophy in the arms, legs and torso. Her movements were severely restricted and she had difficulty turning over, sitting up and eating. Anita was unable to take care of herself and needed assistance from others for daily living requirements.

Nervous System Examination:
Anita was alert but her mental faculties were weak. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and round, the diameter was 3.0mms and the pupils reacted normally to light stimuli. Both eyeballs could move flexibly and the eyelids had strong closing ability. The tongue could reach 2cms beyond the lips. There was atrophy and fibrillation in the tongue muscle. The movements of the tongue were not flexible. The tongue was unable to reach the isthmus or the palate. The teeth were shown without deflection. The soft palate was unable to be raised. The pharyngeal reflex was weak. There was excessive saliva. There was swallowing difficulty. The neck was soft. The swiveling muscle strength was level 3. The shrugging strength of the shoulders was level 3. The muscle strength of the left upper limb's flexor and extensor was level 3. The muscle strength of the right upper limb's flexor and extensor was level 3+. It required a lot of effort to stretch the limbs out and lift them upwards. The upper limbs were unable to be raised off of the bed surface. The muscle strength of both lower limbs was level 3. Both feet were slightly turned inward. The muscle tone of all four limbs was slightly high, with the increase of muscle tone being more obvious with the lower limbs. The feet drooped and she was unable to stand. The tendon reflexes of both upper limbs were active. There was tendon hyperreflexia in both lower limbs. The bilateral ankle clonus was positive. The abdominal reflexes were not elicited. The bilateral palm jaw reflex was positive. The sucking reflex was negative. The left side Hoffmann's sign was negative, the right side Hoffmann's sign was positive. The bilateral Rossolimo's sign was positive. The bilateral deep and shallow sensation was slightly diminished. Anita had difficulty with the examination of the coordinated movements.

Treatment:
We initially gave Anita a complete examination, and she was diagnosed with ALS. She received treatment to improve the blood circulation in order to increase the blood supply to the damaged neurons and to nourish them. At the same time, she was also given daily physical rehabilitation training. After admission, the blood pressure result was slightly low. After she was taken off the antihypertensive medication, her blood pressure was stabilized at a normal level. For this reason, our doctors think the diagnosis of hypertension was incorrect.

Post-treatment:
Anita has more flexible movement to both the left side and right side of her body. The difficulty in swallowing is not as severe. The excessive saliva has noticeably decreased. Her appetite has increased. The muscle strength of the left upper limb's flexor and extensor is level 3+. The holding power of the left hand is level 4. The ability of the left upper limb to be raised upwards has increased. The left upper limb can be lifted off of the bed surface. The left upper limb can almost stretch out completely straight. The muscle strength of the right upper limb's flexor, extensor and holding power is level 4. The abduction muscle strength is level 2. The ability to raise the right arm has improved. The right upper limb can be lifted off the bed surface 7 to 8cms. The muscle strength of both lower limbs is level 4. The muscle tone of both lower limbs is level 4. The muscle tone of all four limbs has decreased. The muscle tone of both lower limbs has decreased more obviously. Anita can stand for 5 minutes. With the support from others, she can walk to the bathroom slowly.


 

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