John Curtis Gibson-1.Ataxia with cognitive impairment; 2.sequelae of brachial plexus injury-(United States)

Patient name: John Curtis Gibson
Gender: male
Age: 83 years old
Nationality: United States
Diagnosis: 1, neurodegenerative diseases: ataxia with cognitive impairment 2, sequelae of brachial plexus injury.

Condition on admission:
The patient was admitted to the hospital mainly because of "memory loss and balance disorder for more than half a year" as "neurodegenerative venereal disease-ataxia and mental retardation". The main symptoms of the patient: his memory loss, his balance disorder, his walking gait was unstable, he was easy to fall, he was injured many times; his speech was slightly vague. The injury of his right brachial plexus was caused by trauma 25 years ago, resulting in the basic loss of sensory and motor function of his right upper limb.

Admission for physical examination:
The patient's blood pressure was 140-160 85mmHg, and his heart rate was 55-65 beats / min. The fall caused a large area of ecchymosis on his right face, and his face and arms were scattered on the bruises. His lungs had clear breathing sounds and no obvious dry-wet rales. He had weak heart sound, occasional arrhythmia and no pathological murmur in each valvular area. His abdomen was flat and soft, and his liver and spleen were not touched under the ribs. There was no edema in his lower limbs.

Nervous system physical examination:
The patient was conscious and his speech was slightly vague. He had a slight decline in memory and calculation, and he was prone to mistakes when he could do three-step calculations by subtraction (He used to be an accountant). His orientation was basically normal. His bilateral pupils were large and round, the diameter was 3mm, he was sensitive to light reflex, his visual field was normal and there was no nystagmus. His forehead lines were symmetrical on both sides, his nasolabial groove was equal to the depth, and he showed no deviation in the corners of his teeth and mouth. His soft palate was lifted forcefully, slightly asymmetrically, his uvula was slightly to the left, and his gills did not leak. He stuck out his tongue in the middle. He turned his neck and shrugged his shoulders strongly on the left, and his right upper limb could hardly move because of trauma. The muscle strength of his left upper limb and lower limb was grade 5, the muscle strength of his right upper limb was grade 1 +, and the biceps and triceps muscle atrophied obviously. He had contracture of the tendon in his right upper limb and normal muscle tension in the rest of his limb. His balance ability was poor, his bilateral finger test and rapid rotation test were inflexible, his bilateral finger nose test and calcaneus knee tibia test were slightly inaccurate, he was difficult to stand positive when he closed his eyes, he could hardly stand on one foot, he couldn't walk in a straight line, and he was easy to fall. The tendon reflex of his right limb was slightly active, while the tendon reflex of his left limb was basically normal. His bilateral pathological signs were negative. He lost the sensation in his right upper limb and felt normal in the rest of his limbs. His meningeal irritation sign was negative.

Treatment process:
The patients were treated with CAST and neural stem cells plus mesenchymal stem cells to repair cerebral neuropathy and brachial plexus injury, nourish nerve, improve internal environment, immunomodulation and cooperated with comprehensive rehabilitation training.

After treatment:
The patient's balance function is significantly improved, never walking in a straight line and falling frequently, to being able to walk independently for a long distance in a straight line, and his gait is obviously stable. His left foot can stand alone for about 3-5 seconds and his right foot can stand alone for 1-2 seconds. The finger nose test and rapid rotation test of his left upper limb are better than before, and his calcaneus knee tibia test is obviously stable. His right shoulder joint can never move to a significantly increased range of motion, his right arm can take the initiative to lift his arm to his chest, and his right hand can complete part of the grip.