Yoshiharu Tanaka-Chronic Inflammatory Demyelinating Polyneruropathoes-(Japan)-Posted on April 13th, 2017

Name: Yoshiharu Tanaka
Sex: Male
Nationality: Japanese
Age: 33Y
Diagnosis: CIDP (Chronic Inflammatory Demyelinating Polyneruropathoes)
Date of Admission: October 25th, 2016
Treatment hospital/period: Wu Medical Center/15days

Before treatment:
Yoshiharu felt back and waist pain 1 year ago, his left leg had intermittent hypesthesia and in January 2016 it was hard for him to go up and down stairs. His balance function became worse when he was running and he often fell over. He had distal muscular tremble and  went to a local hospital in May 2016 where he received an examination of hydrocephalus. The result showed his protein level was higher than normal, the number of cells was at normal range but his balance function was bad. In August 2016 his condition rapidly became worse and he couldn’t stand or walk by himself. His facial muscles were weak and he was unable to chew or swallow well. It was difficult for him to close his eyes or shut his mouth and he spoke some words unclearly. He went to another hospital where they did lumbar puncture, EMG, and other examinations and he was diagnosed with CIDP. He was injected with gamma globulin 400mg/kg/day for 4 days, but he showed no improvement. The deep vein thrombosis resulted in pulmonary embolism so the doctor prescribed anticoagulant therapy. His respiration function and chest pain  improved but his CIDP was still getting worse. Urbason had no positive effect on him. He also did plasma exchange for 6 days without any improvement. He had  motor problems in his arms and legs and was unable to stand up or walk. His arms were able to do some simple work but he wanted a better life so he came to our hospital.
His emotional state, appetite, bladder and bowel functions were all good.

Admission PE:
Bp: 119/81mmHg; Hr: 78/min. RP:20/min. temperature：36.5 degree. His spirit was good, and his nutrition was normal. There was no ecchymosis, petechia or yellow stains on skin. There was no congestion in pharyngeal area. The tonsils were not enlarged. His breathing movement of the thorax was weakening. The respiration in both lungs was clear, no dry or moist rales. Through auscultation, the heart sound was strong, with no murmur in each valve. The abdomen was flat and soft without tenderness or rebound tenderness. The liver and spleen were normal. The borborygmus was normal. There was no swelling in either leg.

Nervous System Examination:
Yoshiharu Tanaka was alert and his speech was clear. His memory, orientation and calculation were normal. He could not stand or walk. Both pupils were equal in size and round, the diameter was about 4.0mm. Both pupils were sensitive to light stimulus. Both eyeballs could move freely to each side. He had no nystagmus. The forehead wrinkle pattern was symmetrical. His tongue was in the center of the oral cavity. The teeth were shown without deflection. There was air leaking when he filled his cheeks. The power of his tongue muscle was weak and chewing power was weak but uvula was normal. His neck movement was normal and the power of shrugging shoulders and turning his head was weak. The  body muscles ware pain free. Bilateral supraspinatus and infraspinatus muscle was wasted slightly. The distal ends of his legs were clearly wasted. The power of his arms were level 4+，the grip strength of both hands were level 4，the power of his legs were level 3+，his left foot could not bend backwards. The four limbs muscular tensions were normal. Tendon reflexes of the four limbs and the abdominal reflex of middle left side could not be identified and  other abdominal reflexes also could not be found. Superficial sensibility of the arms was normal. Below the knees there were hypalgesia on both sides. Below hip joints，there was no tuning fork vibration sensation. His feet had Hyperpathia and the topognosis of joints was poor. Bilateral Hoffmann sign, Rossilomo sign, bilateral palm jaw reflex and bilateral Babinski sign were negative. Bilateral ankle clonuses were negative. Bilateral arm alternate motion and finger-to-finger test was slow. Bilateral heel knee tendon test was shaky. Meningeal irritation sign was negative.

Treatment:
He was diagnosed with CIDP (Chronic Inflammatory Demyelinating Polyneruropathoes). He received 3 neural stem cell injections and 3 mesenchymal stem cell injections to repair his damaged motor nerves, replace dead nerves, provide nourishment to the neurons and to improve the blood supply. This was combined with physiotherapy.

Post-treatment:
After 15 days of treatment, his foot plantar flexion back stretch range was increased，the power of the legs was increased to level 4. He was able to feel pain and warmth below his knees and his tuning fork sensation was improved.