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Mian Muhammad Irfan Khalil-Amyotrophic Lateral Sclerosis(Pakistan)

Author Zhangqi Views Posted at 2016/01/14

Name: Mian Muhammad Irfan Khalil
Sex: Male
Nationality:Pakistani
Age: 35 Years
Diagnosis:Amyotrophic Lateral Sclerosis(ALS)
Date of Admission: Doc. 03, 2015
Treatment hospital/period: Wu Medical Center/18 days

Before treatment:
The patient experienced backache and shoulders weakness 4 years ago without any obvious cause. He also had occasionalfasciculation. The muscle power of his neck
had becomeweak 2 years ago.His shoulders weakness become worse. He began to feel pain and weakness of his left upper limb. He did the rehabilitation training but his condition was getting worse. His lumbosacral region, right upper limb, both lower limbs began to experience weakness. He did EMG 1 year ago;pure motor axon lesions, the left side C5-T1’s myotome was affected.He was diagnosed with Amyotrophic Lateral Sclerosis(ALS). So he took Riluzole but he had less effect. He wore neck support 3 months ago and began to chock 1 month ago.His pain was worse, especially when he maintains the same position.Sometimes he had difficult to breathe. Now, his neck and waist are weak.Both upper limbs could not be moved.The muscle power of his lower limbs was lower than normal. He wants a better life so he came to our centre and was diagnosed withAmyotrophic Lateral Sclerosis.

His spirit was good, he slept and ate well, sometimes he choked.His urination and defecation were basically normal.

Admission PE:
Bp: 124/64mmHg; Hr: 97/min. Br: 22/min. Temperature: 36.7 degrees. Saturation oxygen: 95%, height: 168cm, weight: 55kg. His body development was normal but his nutrition was bad and he was thin. There was no yellow stain or petechia on skin and mucous. The color of his lips was normal. His pharyngeal was not congestion. The tonsil was not enlarged. His thorax was symmetrical. The respiration of both lungs was lower, there was no dry or moist rales. The precordial region was not swollen. The rhythm of his heartbeat was normal and strong.There was no obvious murmur in the valves. The abdomen was soft with no pressing pain or rebound tenderness. The liver and spleen were normal. There was no edema on both lower limbs.

Nervous System Examination:
Mian Muhammad Irfan Khalil was alert and his spirit was good. His memory, calculation and orientation abilities were normal. Both pupils were equal in size and round, the diameter was 3 mms.Both eyes had sensitive response to light stimuli. Both eyeballs could move freely. He had no nystagmus. The nasolabial and forehead wrinkle pattern were symmetrical. The tongue was centered in the oral cavity. He had no teeth deflection.The tongue muscle was slight atrophied.His cheek blowing was abnormal. Both soft palates could be lifted, and the strength was strong. The ability to close his eyes was strong. His neck was soft. The muscle strength for turning over or shrugging shoulders was weak.The muscle power of his waist and back was lower than normal. The muscle power of both upper limbs and forearms was at level 1. The grip of his left hand was at level 1, left ring finger was able to do slight movement. The grip of his right hand was at level 2, right flexor muscle power of wrist was at level 3+.The right thumb, forefinger and middle finger were basically normal. The muscle power of both lower limbs was at level 4+.His four limbs had muscular atrophy.The muscle tension was a little lower. There was occasional fasciculation of his four limbs.The deep sensation and superficial sensation of four limbs was normal. Both side upper limbs’patella tendon reflex was weaker, lower limbs’ patella tendon reflex was active. Right side Hoffmann sign and Rossilimo sign were positive. Both sides Babinski was negative. He couldn’t do the finger-to-nose test and rapid rotation test. Left side finger-to-finger test was not done, right side was hard to do. Both legs’ heel-knee-tibia test was normal. The meningeal irritation sign was negative.
Accessory examination:EMG (2014.3.17, other hospital): pure motor axon lesions, the left side C5-T1’s myotome was affected.

Treatment:
He was diagnosed with Amyotrophic Lateral Sclerosis(ALS), so he received 3 times of neural stem cell injection and 3 times of mesenchymal stem cell injection to activate the cells, nourishes neurons, fix the damaged cells, protect his heart, improve circulation and immunity. He also used non-invasive ventilator for breath and had physical rehabilitation.

Post-treatment:
After 2 weeks of treatment, his breath was normal, SAT was 96-98%, hischokes havedecreased. He had less muscle pain and took no painkillers.He had less fasciculation. The muscle power of his four limbs was better, his right hand is more power. His right upper limb could do translatory movements easier than before.The extent of movement was greater.The muscle power of his left upper limbs was at 1+, and right upper limb was at 2. He could walk longer.His condition was better and he had better exercise tolerance.

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