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Martin - MSA (America) Posted in Febuary 17, 2014

Author Julia Views Posted at 2014/02/17

Name: Martin

Sex:Male

Age:61 years old

Country: USA

Diagnosis: (MSA)

Admission Date: 2014-01-02

Days Admitted to the Hospital:28

Before treatment:

The patient suffered from walking instability and this aggravated gradually for 2 years ago. He also suffered from urinary incontinence and dyschezia (difficulty in defecation) for a year ago. He used Darifenacin and drug to soft the defecation. He still had urine incontinence. The patient also had orthostatic hypotension about 6 months ago. The highest level reached 200/120mmHg and lowest reached 90/60mmHg. He used Isradipine and midodrine to control the blood pressure, but the effect was not good. The patient also had speech disorders and coughs when he tries to swallow. He was diagnosed with Multiple system atrophy in American 3 months ago. From the onset of the disease, the patient had normal sleep quality and diet. With the drug control, the bowel movement was normal and the urine incontinence. His weight was alleviated (stable or increased or decreased not alleviated) than before. There was no history of familial hereditary disease.

The patient couldn't walk, turn over. He had urinary incontinence, speech disorder, cough when swallowing and weakness of whole body. For further treatment, the patient was transferred to our hospital.

Admission PE:

Temperature: 36.5degrees. Supine blood pressure: 127/85mmHg; The sitting blood pressure: 90/60mmHg. Heart rate: 85/min. The whole body presented with no superficial lymph nodes enlargement. The respiratory sounds in both lungs were clear, with no moist or dry rales. The heart sound was strong; the cardiac rhythm was regular, with no obvious murmur in each auscultation area of the valves. The abdomen was enlarged, with no pressing pain, rebound tenderness or enclosed masses. There was no percussion pain in liver and kidney area. There was slight edema in the ends of all his four limbs.

Nervous System Examination:

Martin was alert and his spirit was poor. The speech was not very fluent while the tone of his speech was low. He also had difficulty in swallowing. He can perform memory, calculation, and orientation examination normally. Both pupils were equal in size and round. The diameter of both pupils was 2.5mms and both pupils were sensitive to light stimulus. There was nystagmus. Both eyeballs were not able to move to the inner or outer corner of the eyes. Both eyes were restricted to look upwards. The forehead wrinkle pattern was symmetrical and he was able to close eyes with ease. When it was protruded, his tongue was in the center of the oral cavity but the tongue was slightly trembling. The biting ability of both sides of the month was weak. He could drum cheeks normally. The muscle strength for the muscle used to raise the soft palate was weak. The uvula was in the center of oral cavity. There was no muscle tension on the neck. The muscle strength of his upper limbs was at level 5 and that of his lower limbs was at level 4. The muscle tone of his right upper limb and lower limbs were higher than normal while that of his left lower limb was normal. The tendon reflex of his four limbs was weak and bilateral abdominal reflex was weak. The sucking reflex was negative and the bilateral palm jaw reflex was negative. The bilateral Hoffmann sign was negative and the bilateral Rossilimo sign was negative. Bilateral ankle clonus was negative. His deep and shallow sensations were normal. He performed the finger-to-nose, rapid rotation, and digital opposition examinations in an unstable and clumsy manner. The patient had volitional tremor. He performed the heel-knee-tibia test in an unstable manner. He could not turn over or sit-up himself. Meningeal irritation sign was negative.

Treatment:

At the beginning of his hospitalization, the patient was caught up with respiratory infection from a long tiring trip and he also had cold due shower. He received anti-infective and symptomatic treatment in time and he was healed. In his hospitalization, he was found to have sleep apnea over 5 times per hour and the blood oxygen saturation decreased to 90%; he had fasting blood �Cglucose test and blood-glucose 2 hours after meal for several times, all the results were abnormal. After the admission, the patient received the relevant examinations. He was diagnosed with 1.Multiple systems atrophy; 2.Upper respiratory infection; 3.Stage III hypertension; 4.Hyperlipidaemia; 5.Diabetes type 2; 6.Sleep apnea syndrome. He was given non-invasive ventilator to assist his breathing. He received treatment for nerve regeneration and activated stem cells. He also received treatment to improve the blood circulation, to provide nourishment for the neurons and also to activate neural cells. He received treatment to regulate blood glucose, blood lipid, and blood pressure. These were accompanied with physical rehabilitation training.

Post Treatment:

At present, the patient is alert and in good spirit. The sleep apnea symptom has been alleviated and the blood oxygen saturation increased to 98%-99%. The patient is in good nutrition status. The ingestion and excretion are balanced. The edema has vanished. The blood glucose level is basically normal and the blood lipid level has improved. After the treatment the patient's speech is clearer and stronger than before. The coughing accompanied with swallowing has reduced. The nystagmus of both eyes has vanished. The eyeballs move more flexibly than before. The volitional tremor of his upper limbs has been alleviated. The tendon reflex of his limbs and muscle tone of his limbs are normal. His blood pressure is under control and it is in a stabilized range. The orthostatic hypotension has been alleviated. Urgent and frequent urine has been alleviated. The urinary incontinence has vanished.

 

 

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