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Minah-Multiple System Atrophy-(Indonesia)

Author Zhangqi Views Posted at 2016/08/16

Name: Minah
Sex: Female
Nationality: Indonesian
Age: 67
Diagnoses: 1. Multiple System Atrophy: Progressive Supranuclear Paralysis 2. Upper respiratory tract infection, Secondary hyponatremia and hypochloraemia 3. Sleep Apnea Syndrome 4. Hypertensive 5. Diabetes type 2 6. Hyperlipemia 7. Right upper arm’s contusion
Date of Admission: May 8, 2016
Treatment hospital/period: Wu Medical Center/14 days

Before treatment:
Minah was not able to stop walking 8 years ago, and if she wanted to stop, she would fall down. This condition continued to worsen, she needed someone to help her walk, and her limbs had stiffened. Minah’s family members took her to a hospital in Singapore where she was diagnosed with Parkinson's syndrome, so the doctor prescribed some medicine for her to take for about 6 months. Her condition did not improve. She went to another hospital four years ago, and based on her condition and examination results, the doctor diagnosed her with progressive supranuclear paralysis. Her condition continued to worsen and she became bedridden. It was hard for her to speak or walk, and she could barely take care of herself. She wanted a better life so she was taken to our hospital.
She sleeps well, her diet, urination and bowel movements are normal. Her weight has not changed since she developed the disease.

Admission PE:
Bp: 166/96mmHg, Hr: 65/min, body temperature: 36.4 degrees, Br: 19/min. Minah’s body type was normal, she was in a normal nutritional situation. The respiratory sounds in both lungs were clear and there were no dry or moist rales. The heart sounds were low and dull with no obvious murmur in the valves. The abdomen was bulged and soft, with no masses or tenderness. The liver and spleen were normal. There was no edema in the lower limbs.

Nervous System Examination:
Minah was alert, but she felt depressed. She spoke slowly and her voice was low. Her memory, orientation and calculation ability were normal. Her reactions and comprehension were basically normal. Both pupils were equal in size and round, the diameter was 2.5mm. Both pupils lagged in their responses to light stimulus. Her eyeballs were covered with some secretion, her eyes would constantly tear up, and both eyeballs gazed upward. It was difficult for her to move her eyeballs to the left, right or down. It was difficult for her to do the blinking reflex. She was able to close her eyes strongly. She was not able to raise her eyebrows, her facial expressions were stiff.
The bilateral nasolabial sulcus was equal in depth. Her tongue was centered. She was not able to move her tongue well. It was weak when she raised her soft palate. Her neck had no resistance; it was hard for her to turn her neck, especially to the left side. The muscle power of her right upper limb was at level 4, the left upper limb was at level 4-, and her grip showed no wax-waning sign. The muscle power of the right lower limb was at level 3+, the left lower limb was at level 3. The muscle tension was normal when she relaxed, but when she moved, all four limbs were stiff. The bilateral biceps reflex was normal. The bilateral tendon reflex was normal. The Achilles reflex was weak, the abdominal reflex was abnormal. The deep sensation and superficial sensation were normal. The sucking reflex was positive. The bilateral Hoffman’s sign was negative, the bilateral palm jaw reflex and Babinski’s sign were positive. She was able to do the rapid rotation test, finger-to-nose test, finger-to-finger test and heel-knee-tibia test, but slowly and in an uncoordinated manner. She was not able to cooperate with the Romberg’s sign examination. The meningeal irritation sign was negative.

Treatment:
After the admission, Minah was diagnosed with 1. multiple system atrophy: progressive supranuclear paralysis 2. upper respiratory tract infection 3. sleep apnea syndrome 4. hypertensive 5. diabetes type 2 6. Hyperlipemia. She received 3 neural stem cell injections and 3 mesenchymal stem cell injections to nourish the nerves, improve the blood circulation, allow her to move her body better, regulate the blood pressure, blood lipid and blood sugar level. Minah was put on a breathing machine to control her breathing pattern: BiPAP/ST, Br 14/min, IPAP9cmH2O, EPAP4cmH2O. Her blood test result was higher than normal. The sputum culture showed an alvein infection and was accompanied with hyponatremia and hypochloraemia, so she was diagnosed with an upper respiratory tract infection, secondary hyponatremia and hypochloraemia. The doctor gave her an intravenous injection of antibiotics. Minah fell down some days before, this resulted in a left upper limb proximal muscle sprain, so the doctor treated her with antipyretic analgesics and her condition improved. 

Post-treatment:
After 14 days of treatment, Minah was able to speak clearer and her voice was louder. Her swallowing function was better, and she choked less when she ate. Her limbs were powerful, the muscle power of the upper limbs was at level 4+, the gripping power was at level 5-, and the muscle power of both lower limbs was at level 4+. Her upper limbs were more flexible while doing the finger-to-nose test, finger-to-finger test and rapid rotation test. Her balance was better than before, it was easier for her family members to support her when she walked. Her exercise tolerance was better.

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