Kim-Multiple System Atrophy-(USA)
Before treatment: Admission PE: Nervous System Examination: Treatment: Post-treatment: 
Name: Kim
Sex: Male
Nationality: USA
Age: 70Y
Diagnosis: Multiple System Atrophy (MSA)
The patient felt weak in his legs 2 years ago, he could write well but he had balance problems. His condition got worse and worse and he was diagnosed with MSA 1 year ago. He walked slowly and showed postural hypotension, he couldn’t speak well and he had less facial expression, restless legs at night, urination problems and increased nocturia. At present he can’t speak clearly, has less facial expression, balance problems and a wide gait. It is hard for him to turn over his body and he has memory problems.
His diet is normal, he sleeps less at night and he has constipation.
Supine blood pressure: 140/98mmHg, standing blood pressure: 100/50mmHg, Hr: 78/min, breathing rate: 18/min, body temperature: 36.7 degrees. Height is 166cm, weight 76Kg. The patient displays an unstable gait with a wide and slow step pace. His nutrition status is good and he has normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht and no tonsil swelling. The chest development is normal and chest movement was basically normal. Breathing sounds of both lungs were clear with no obvious dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was soft with no masses or tenderness. The liver and spleen were normal and there was no edema of the legs.
Patient was alert and displayed dysarthria with slow speech. He had a normal comprehension ability but the memory was not good enough and the calculation ability was normal. He had reduced facial expression, both pupils were equal in size and round, diameter of 2.5 mm, react well to light and the eyeballs can move freely. There was no nystagmus. Bilateral forehead wrinkle and nasolabial fold are symmetrical. He could make his tongue extend out normally, there was no tongue muscle tremor, the tongue could not move flexibly, the soft palate could lift powerfully, there was no uvula and he could turn his neck powerfully. The muscle power of the 4 limbs was 5 degrees and there was normal muscle tone. The arms coordinate movement was not very good. He could sit up or walk slowly but when he walked he tended to lean to left side with a slow and wide step pace. He could turn round slowly. Bilateral biceps reflex, triceps reflex and radial periosteal reflex were normal. The patellar tendon reflex and Achilles tendon reflex could not be induced. Bilateral Hoffmann sign, Rossilimo sign of both sides and the Palm-jaw reflex of both sides were all negative. The Babinski sign was positive. His sensory system was normal by gross measure. The finger to nose test and finger opposite movement were not stable. The fast alternate movement was clumsy and whilst he could perform the heel-knee-tibia test it was not very stable. He could not stand with one leg, the meningeal irritation sign was negative.
After the admission he received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair his damaged nerves, replace dead nerves, monitor cells function, nourish nerves (gangliosides and neurotrophic factors), regulate his immune system and improve blood circulation. This was combined with rehabilitation training.
After 14 days treatment he spoke better and clearer, his dizziness reduced, the blood pressure change from lying posture to standing position decreased to; Supine blood pressure: 130/80mmHg, standing blood pressure: 118/85mmHg. His hands could now do fine movement better, he wrote better and he moved his legs easier. His movement endurance improved, balance control got better, he could now stand with right leg for 15s and with the left leg for 20s. He walked better, urinated less at night and he now slept well.
