Natalia - Amyotrophic Lateral Sclerosis (Russia) Posted on February 21, 2012

Name: Natalia                      
Sex: Female
Country: Russia
Age: 56
Diagnoses: ALS (Amyotrophic Lateral Sclerosis), dyslipidemia
Admission Date: 2011-12-03
Days Admitted to Hospital: 27

Before Treatment:
Natalia developed myasthenia in the left arm 3 years ago with no obvious cause. She was still able to function in everyday life. Eventually she developed myasthenia in her right hand and was unable to grasp things or write. She went to the local hospital and received a head CT and spinal cord examination but there was no clear diagnosis given at that time. Natalia was prescribed some medications and received physical rehabilitation but the results were minimal. Three months ago, the myasthenia in the right hand, left arm and right leg continued to get worse. Natalia would drag her feet when she walked. She received an MRI of the spinal cord and an EMG examination and was diagnosed with amyotrophic lateral sclerosis. She received related treatment but her condition had little improvement. When Natalia was admitted to our medical center, she her symptoms had become so severe that she was completely unable to function in daily life.

Nervous System Examination:
Natalia was alert and she was in good spirits. The voice was normal, but the pronunciation was not clear. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and round. The diameter was 3.0mms. The eyeballs could move freely and the pupils reacted normally to light stimulus.The forehead wrinkle pattern was symmetrical. The eye closing ability was strong.The bilateral nasolabial sulcus was equal in depth. The tongue was centered in the oral cavity. There was no obvious atrophy or tremors in the tongue. The teeth were shown without deflection. There was air leakage when the cheeks were expanded. The cheek muscles were strong and symmetrical. The soft palate could be raised normally. There was obvious atrophy in the supraspinatus muscles, infraspinous muscles, deltoid muscles, forearm muscle group, interosseous muscles of both hands, and the large and small thenar muscles. The muscle strength of the right upper limb's proximal-end was level 2-; the muscle strength of the right upper limb' s distal-end was level 3-. The grasping strength of the right hand was level 0. The muscle strength of the left upper limb's distal end was level 3+; the muscle strength of the left upper limb's proximal-end was level 4-. The range of motion of the left upper limb is shorter than normal. The range of motion of the left shoulder joint could only extend to 90 degrees. The muscle strength of the right lower limb was level 4-; the muscle strength of the left lower limb was level 5-. The muscle tone of both lower limbs was slightly high; the muscle tone of both upper limbs was normal. The bilateral deep and shallow sensations were normal. The tendon reflexes of all four limbs were active. The abdominal reflex was not elicited. The left side palm jaw reflex, Hoffmann's sign and Rossolimo's sign were positive. The right side palm jaw reflex, Hoffmann's sign and Rossolimo's sign were negative. The bilateral Babinski's sign was positive. The right side couldn't finish the rapid rotation test or digit opposition test. The left side could finish the rapid rotation test, but in a clumsy manner. The left side couldn't finish the digit opposition test. She couldn't cooperate with Romberg's sign test. She could finish the heel-knee-shin test. There were no signs of meningeal irritation.

Treatment:
We initially gave Natalia a complete examination. She received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves and to nourish the neurons. She also received treatment to improve her immune system. This was combined with physical rehabilitation training.

Post Treatment:
Natalia's condition has improved. The speech is clearer than before. There was some air leakage when the cheeks were expanded. The muscle strength of the left upper limb has improved. The muscle strength of the left upper limb's proximal-end is level 4-. The muscle strength of the left upper limb's distal-end is level 4+. The range of movement of the left upper limb has been increased. The range of movement of the left shoulder joint can extend to 135 degrees. The muscle strength of the right lower limb is level 5-. The tendon reflexes of both upper limbs have been reduced. The index finger, middle finger, and ring finger on both hands can point to the thumbs. The rapid rotation test results of both sides have improved.

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