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Raed - Sequelae of cerebral hemorrhage and secondary epilepsy (Yemen)

Author Admin Views Posted at 2013/02/20

Name: Raed Faisal IBRAHTM                  
Sex: Male
Country: Yemen
Age: 37
Diagnoses: 1. Sequelae of cerebral hemorrhage and secondary epilepsy   2. Hyper prolactinemia  3. Hyper lipidemia
Admission Date: 2012-12-17
Days Admitted to Hospital: 51 days


Before treatment:
Raed Faisal IBRAHTM suffered from seeing double and constant headaches starting 3 years ago. He went to the local hospital for treatment. His blood pressure then was recorded at 150/100mmHg. During the CT examination, the patient suffered from a sudden loss of consciousness. The CT of the head showed he had had a hemorrhage in the brain stem. The patient was sent to ICU for treatment. He received an operation to clear up the hematoma. He also received a ventricular drainage to alleviate the pressure of the encephalocoele. Two weeks later, the patient received a tracheotomy and a gastrostomy. About 4 or 5 weeks later, the patient woke up gradually; But the patient's reaction and cognitive ability was reduced obviously. Both his eyeballs had limited movement. He laso had weakness of four limbs and asyndesis. After treatment, the patient's condition was stable, so the patient was sent to Germany for 6 months rehabilitation training. The patient's motor ability, reaction capacity and cognitive functioning were better than before. About 4 months later, the patient was discharged from the hospital and went home, but about 75 days later after discharge, the patient's motor ability and cognitive function slowed down. He presented a slow response, Bradykinesia and so on. The Parkinson's disease after cerebrovascular disease was considered. The patient received antiparkinsonism drug for treatment. At present, the patient's comprehension and response ability progressed. He needed the assistance of long limbs (crutches) to walk. He had difficulty with turning over in bed and so on. He couldn't take care of himself, needed assistance to do the most medial things.

Nervous System Examination:
The patient was alert. He had poor spirit. He also had a speech disorder, difficulty with opening mouth and showed a slow response.He had involuntarily grope action and slow response. He also had difficulty with open mouth. He had poor memory ability and calculation. The examination of orientation and comprehension were almost normal. The left eye was weaker to close. Both pupils were not equal in size, the diameter of the left eye was 2.0mms and the diameter of the right eye was 2.5mms. Both pupils reacted slowly to light stimulus. Both eyeballs outreach were more to the right side. Both eyeballs have restricted movement towards the left direction and downwards direction. Both eyeballs could move to the other side almost freely. There was horizontal nystagmus. When he stared at the left side, there was double image. The forehead wrinkle pattern was symmetrical. He could chew normally. The movement in the corner of the mouth was not flexible when he showed his teeth. The movement of the tongue muscles was not flexible. The tongue couldn't extend to outside the lips. There was no atrophy of the tongue muscle. He had normal hearing. The muscle strength when shrugging his shoulders was weak. The muscle strength of the left upper limbs near end was level 3-. The muscle strength of the left upper limb's far end was level 3+. The hold power of the left hand was level 3-. The muscle strength of the right upper limb was level 4. The hold power of the right hand was level 4. The muscle strength of the left lower limb was level 3-, the muscle strength of the right lower limb was level 3+. The muscle tone of the four limbs was almost normal. There was a contracture of the right ankle joint. Left foot inversion. Bilateral abdominal reflexes were elicited normally. The tendon reflex of four limbs was weak. Bilateral palm jaw reflex was positive. The sucking reflex was positive. Bilateral Rossilimo sign and Hoffmann sign were negative. Bilateral Babinski sign was positive. The pinprick sensation of left lower limb was slow down. The deep and shallow sensation and the sophisticated sensation of both upper limbs were almost normal. He had uncorrected topesthesia in both lower limbs. He was able to finish the finger-to-nose test, the rapid rotation test and the digit opposition test, but in a slow manner.  His right side could finish the heel-knee-shin test in a stable manner, but left could not. There were no signs of meningeal irritation.

Treatment:
Raed Faisal IBRAHTM was diagnosed with sequelae of cerebral hemorrhage. He received treatment to nourish the brain cells, to improve the blood circulation and protect his liver. The anti-epileptic drugs were adjusted for treatment. This was accompanied with rehabilitation training.
 
 Post-treatment:
Movement aspects: The power of gripping has increased more than before. The muscle strength of shrugging his shoulders has increased too. The movement in both the upper limbs is more flexible than before. The muscle strength of both lower limbs has increased by 1 level. When single leg straightens and raises, he can stand up to some resistance. He can now turn over and sit up more flexibly. The right ankle can almost press close to the floor when he is standing near the bed. Both lower limbs can now do the heel-knee-shin test more stably and rapidly. The tendon reflex of four limbs are almost normal. The eyeball movement and vision aspects: Both eyeballs can move to the left side and upward more flexibly. He can look through the left side more clearly. He can distinguish the number of fingers in certain field of view. Organ function aspects: The liver function is restored to normal. The heart rate is stable between 60-80/min. The blood pressure is stable between 110-120/60-80mmHg. The cardiopulmonary function is more stable than before. Other aspects: the patient has a better mental status. He has a better response and understanding. He has less groping conditioning in the night. The epilepsy is under control. He can open mouth larger. The movement of the tongue is more flexible. The cough is alleviated when he eats food. The involuntary groping actions are more alleviated than before.

2013-04-01

Hello My Dear ,

Here it is Our Brother Report for last weeks . he is much better this days , i hope he become better and better.

Miss u and Love you so Much

Your Mosquito
Alaa

Name: Raed Faisal IBRAHTM                  
Sex: Male
Country: Yemen
Age: 38
Diagnoses: 1. Sequelae of cerebral hemorrhage and secondary epilepsy 2. Hyponatremia  3. Hyperlipidemia 4. Dysfunction of liver  5. HepatitisAdmission Date: 2014-02-07
Days Admitted to Hospital: 28 days

Before treatment:
The patient came to our hospital 1 year ago. After treatment, his four limbs activity and epilepsy were better than before. His left vision and cardio-pulmonary function were better than before. His spirit was more stable. For further progress, the patient came to our hospital again.

Admission PE:
Bp: 125/60mmHg; Hr: 72/min. Nutrition was normal. With the assistance of family member, he could walk slowly. The respiratory sounds in both lungs were clear with no signs of dry or moist rales. The heart sound was strong and the heart rhythm was regular. The abdomen was expanded slightly. There was no pressing pain or rebound tenderness. The liver and spleen were not palpable under the ribs. There was no edema in both lower limbs.

Nervous System Examination:
The patient was alert. He had poor spirit. He also had a speech disorder, difficulty with opening mouth and showed a slow response. He had poor recent memory ability. The examination of calculation, orientation and comprehension were almost normal. He could close his eyes powerfully, but the left eye was weaker than the right eye. Both pupils were not equal in size, the diameter of the left eye was 2.5mms and the diameter of the right eye was 2.3mms. Both pupils reacted slowly to light stimulus. Both eyeballs outreach was more to the right side. Both eyeballs had restricted movement towards the left direction or downwards direction. Both eyeballs could move to the other side almost freely. There was   horizontal nystagmus. He saw object in pairs when he stared at the left side. The forehead wrinkle pattern was symmetrical. He could chew normally. The movement in the corner of the mouth was not flexible when he showed his teeth. There was coughing when he drank water. He also had swallowing difficulty. The movement of the tongue muscles was not flexible. The tongue only could extend to the lips. There was no atrophy of the tongue muscle. He had normal hearing. The muscle strength when he shrugged his left shoulder was strong, but the muscle strength when he shrugged his left shoulder was weak. The muscle strength of the left upper limbs near end was at level 4 and the far end was at level 4-. The grasp power of left hand was at level 4+. The muscle strength of the left upper limb was at level 4+. The grasp power of the right hand was at level 5. The muscle strength of the left lower limb was at level 4. The muscle strength of the right lower limb was at level 4. The muscle strength of four limbs was almost normal. There was a contracture of the right ankle joint. Left foot inversion. He couldn't walk. Bilateral abdominal reflexes were slightly weak. The tendon reflex of his four limbs was weak. Bilateral palm jaw reflex was positive. The sucking reflex was positive. Bilateral Babinski sign was positive. The pinprick sensation of the left lower limb was weaker than normal. Other shallow sensations of the whole body were almost normal. The deep and shallow sensation and the sophisticated sensation of whole body were almost normal. He was able to finish the rapid rotation test and the digit opposition test, but in a slow manner. His left side did the finger-to-nose test in an unstable manner. Right hand did the finger-to-nose test slowly. His right side could finish the heel-knee-shin test in a stable manner, but left side did the heel-knee-shin test in unstable manner. There were no signs of meningeal irritation. The laboratory showed his liver function was abnormal. He had hyponatremia.

Treatment:
The patient received treatment for nerve regeneration, nerve regeneration and activate the stem cells in the body. At the same time, the patient received treatment to nourish brain cells, to improve the blood circulation and protect his liver. He also received treatment to treat hyponatremia, improve cognitive function and adjust antiepileptic drugs. This was accompanied with rehabilitation training.

Post-treatment:
The patient's neurological function made further progress. Movement aspects: He constructs the sound more clearly. Both hands can finish coordinated movement more flexibly. He can act more quickly. The contracture of left ankle is alleviated. The right ankle can fit floor when he stands. He can finish the heel-knee-shin test in a more stable manner. The patient can crawl 3 meters. With some assistance, the patient can walk more flexible. The eyeball movement aspects: The angle is enlarged when he stares at left side. Occasionally, he can see big object at left down side. The nystagmus has been alleviated. Oral movement aspects: he can open mouth bigger. The movement of tongue is more flexible. He can stretch tongue outside the lips. Cognitive function aspects: his calculation power and recent memory are better than before. His diet, sleep and epilepsy are stable. The laboratory test showed the liver function has significantly progressed. The hyponatremia has been cured.

 Date: Sep 15, 2014, at 9:06 AM

Hi dear sister
Dr. Wu has seen the results of blood tests. All of them are normal. Especially the liver function is better than before. Happy happy happy! !!
So doctor suggest that let ur brother to take the medicine following the medicine list which we gave you on 9th Sep.
Please feel free to let me know.
Best regards
Your oxygen

Lisa


Date: Mon, 15 Sep 2014   19:15

Hello dear Lisa

That is great great news
Thanks God
Avout the medicine:  finasteridum it is not available  hear
Is there is any other names we can use or we must let him take it ?
Or what we can do ?

Love u so

--
Regards,

AlaaFaisal.see.me

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