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Metteo-- Multiple system atrophy (Italy)

Views Posted at 2013/05/30

Name: Matteo
Sex: Male
Country: Italy
Age: 69 years
Diagnoses: 1. Multiple system atrophy; 2. Diabetes type 2; 3. Hyperlipidemia; 4. Benign Prostatic Hyperplasia; 5. Plasma hyperhomocysteinemia
Admission Date: 2013-04-24
Days Admitted to the Hospital: 28

Before treatment:
The patient was presented with progressive weakness in both lower limbs and rigidity. The weakness was progressively aggravated. The patient also had equilibrium disorders and difficulty with turning round. The patient had tremors of the limbs when he was under mental strain. He went to the local hospital and received an MRI of the head. He was diagnosed with Multiple system atrophy. He took Madopar, Pramipexole Dihydrochloride and Rasagiline. The tremor symptoms were not severe. 6 months later, the patient presented with speech disorders, salivation, swallowing difficulty, cough while drinking, urinary incontinence, constipation, weakness of limbs and stiffness. The patient had edema of the lower limbs. He also had tremors, swallowing difficulty, speech disorder and motor function slowing down gradually.

Admission PE:
Bp: 125/86mmHg; Hr: 88/min. The respiratory sounds in both lungs were unclear. The breath sounds in both lungs were low and dull, with no obvious murmur. The abdomen was flat and soft, with no pressing pain or rebound tenderness. There were no palpable masses. There was edema in the lower limbs. The skin was dry and the color of the skin was cyanosis. There was pain in the neck, shoulders and left foot's heel.

Nervous System Examination:
Matteo was alert. The speech was unclear. The patient had too much salivation and had difficulty with swallowing. He suffered a cough when he swallowed food. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and round. The diameter of both pupils was 2.0mms and both pupils were sensitive to light stimulus. Both eyeballs could move freely. There was no nystagmus. The forehead wrinkle pattern was symmetrical. The nasolabial sulcus was equal in depth. The teeth were symmetrical. There was a slight tremor in the tongue. Both soft palates could be raise normally. The muscle strength of swivel and shrug shoulders were strong. The muscle strength of the four limbs was normal. The muscle tone of both upper limbs was increased intermittently. The muscle tone of both lower limbs was normal. There was no amyotrophy. He had difficulty with getting up and needed some assistance to stand up. He walked slowly and turned round slowly. Bilateral biceps reflex, radioperiosteal reflex, triceps reflex and patellar tendon reflex were normal. Bilateral abdominal reflexes were normal. Bilateral Hoffmann and Rossilimo sign were negative. Bilateral sucking reflex was negative. Bilateral palm jaw reflex was negative. Bilateral Babinski sign was negative. The examination of the sensory system showed no obvious abnormalities. The patient did the finger-to-nose test, rotation test and digital opposition test awkwardly. He did the heel-knee-shin test slowly. The meningeal irritation was negative. The MRI of the head showed: there was atrophy of brain, parencephalon and brain stem.

Treatment:
After admission, the patient received the relevant examinations. He received treatment to improve the blood circulation, eliminate oxygen free radicals, nourishment for the neurons, to protect the heart and reduce the level of homocysteine. He received treatment to treat and prevent Benign Prostatic Hyperplasia. He also received treatment for nerve repair, nerve regeneration and activated autologous stem cell. This was combined with physical rehabilitation training. 

Post Treatment:
The patient has better mental status. There is no longer any rigidity in the trunk or weakness in the limbs. His speech is clearer than before. The The swallowing difficulty is not severe. The salivation is reduced, too. The edema of the lower limbs is alleviated. The skin color is almost normal. The slight tremor of the tongue has been alleviated. The tremor of both hands is alleviated. The movement of the fingers of both hands is more flexible. He can stand up and turn round better. The posture is almost normal when he stands or walks. The differential of blood pressure in recumbent position and erect position is less than 20mmHg. The patient has occasional dizziness in the standing position. He is able to do the finger-to-nose test, rotation test and digital opposition test in a stable manner. Bilateral heel-knee-shin test is stable. The blood sugar level showed the blood sugar is under control. The HCY level is restore to a normal level.

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