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Jorge - Amyotrophic lateral sclerosis (Argentina)

Author Admin Views Posted at 2012/05/18

Name: Jorge Francisco Llamazares                 
Sex: Male
Country: Argentina
Age: 64
Diagnoses: ALS (Amyotrophic lateral sclerosis), hypertension 1 level, Post heart bypass surgery
Admission Date: 2012-03-16
Days Admitted to Hospital: 28

Medical History:
Jorge developed swallowing difficulty in 2008 but did not seek treatment at that time. He was diagnosed with amyotrophic lateral sclerosis at his local hospital. Soon after, additional symptoms appeared including muscle atrophy and weakness in the neck and arms, as well as myofacial pain syndrome. Two years ago, Jorge developed speech problems and breathing difficulty. Since then, he has had to use a non-invasive ventilator to help his breathing and he has to lie on his side to fall asleep. Throughout this time, the symptoms continued to worsen and currently Jorge's physical endurance has decreased and now he also has poor control over the movements of his neck and arms and has increasing difficulty with chewing and swallowing his food. 

Admission PE:
Bp: 140/80mmHg; Hr: 92/min, temperature: 36.8 degrees. When the breathing is relaxed, the peripheral oxyhemoglobin saturation fluctuates between 90% and 94%. While using a nasal catheter or a non-invasive ventilator, the peripheral oxyhemoglobin saturation fluctuates between 94% and 97%. The treatment plan has been completed. The respiratory sounds in both lungs were weak. The cardiac rhythm was regular, with no obvious murmur. The abdomen was soft and there was no pressing pain or rebound tenderness. The liver and spleen were not palpable. There was a 10cm long surgical scar in the chest and there are 2cm long surgical scars on the abdominal area.

Nervous System Examination:
Jorge was alert and he was in good spirits. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and round, the diameter was 2.0mms, and both pupils had sensitive responses to light stimulus. The eyeballs could move freely. The forehead wrinkle pattern was symmetrical. The eye closing ability was strong. The muscle strength of the tongue was weak and the tongue could only extend out as far as the lips. There was atrophy in the tongue muscle. The teeth were shown without deflection. There was difficulty with expanding the cheeks. The raising ability of the soft palate was weak. There was obvious muscle atrophy in the bilateral supraspinatus, infraspinous, deltoids, latissimus dorsi, trapezius, pectoralis major muscle, biceps brachii, triceps brachii, forearm muscles and small and big thenar. He had difficulty with shrugging shoulders. The muscle strength of the upper limbs' proximal-end was level 1 and the muscle strength of the distal-end was level 3. The muscle strength of both lower limbs was about level 4. The muscle tone of all four limbs was almost normal. The tendon reflexes of both upper limbs were weak. The tendon reflexes of both lower limbs were active. The abdominal reflexes were not elicited. The bilateral palm jaw reflex was positive. The Hoffmann's sign was negative. The bilateral Babinski's sign was negative. The bilateral deep sensation and shallow sensation through coarse measure were normal. Jorge couldn't finish the finger-to-nose test or the rapid rotation test because of the weak muscle strength. He was able to finish the digit opposition test and the heel-knee-shin test in a stable manner.

Treatment:
We initially gave Jorge a complete examination and he received a clear diagnosis. He received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves and to nourish the neurons. He also received treatment to promote neural repair. This was combined with physical rehabilitation training. During the hospital, in resting state, the patient��s blood pressure was higher than normal for many times. He was diagnosed with hypertension 1 level. He took blood pressure-lowering medication.

Post-treatment:
At present, Jorge's condition has improved. The speech is clearer and he can speak longer sentences. The swallowing ability is better than before and the amount of excess salivation has decreased. The muscle strength of the tongue has improved and the tongue can be extended out beyond the lips. The muscle strength of the soft palate has increased. The shoulders are able to shrug but the muscle strength is still weak. The breathing ability as improved and there are respiratory sounds in both lower lungs, but the sounds are still weaker than normal. When the breathing is relaxed, the peripheral oxyhemoglobin saturation fluctuates between 93% and 98%. While using a nasal catheter or a non-invasive ventilator, the peripheral oxyhemoglobin saturation fluctuates between 95% and 100%. The liver function is restore to normal level. The creatase level distinctly dropped.

 

 


 

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