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Endah Prasanti-Hereditary Sensory-Motor Axonalpolyneuropathy(Indonesia)

Author Zhangqi Views Posted at 2017/03/22

 

Name: Endah Prasanti
Sex: Female
Nationality: Indonesian
Age: 39Y
Diagnosis: 1. Hereditary Sensory-Motor Axonalpolyneuropathy
2.Second degree Atrio-ventricular Block
3. Multiple Nodules of Thyroid left lobe
4. Mild Pelvic Effusion
Date of Admission: Sept. 9th, 2016
Treatment hospital/period: Wu Medical Center/15days

Before treatment:
Endah felt her left leg was numb and weakness 5 years ago without any reasons, after that, her right leg became weakness and numbness too. She went to local hospital and did lumbar X-ray examination, but the result showed no abnormal. She did rehabilitation training for a year without any improvement. Her condition became worse 2 years ago, she went to hospital again and did MRI, the result showed there was proplapse of lumbar intervertebral disc from L5 to S1, she did a surgery and she had a obvious improvement in 6 months, but 6 months later, her condition became worse, her legs were weakness, she had balance disturbance, her upper limbs became numb, too, her balance was bad, it was hard for her to write. At present, the muscle power of limbs was weak, terminal sensation of four limbs is decreased, she has balance disturbance, it is easy for her to feel tired. She is able to walk 20-30 minutes, she could take care of herself partly, she wants a better life, so she comes to our hospital.
Her spirit and sleep are good, she eats 5 meals each day. She won’t be choked when she drinks, her urination is normal. She has diarrhea and constipation alternately.

Admission PE:
Bp: 109/72mmHg, Hr: 78/min, body temperature: 36.5 degrees. Breathing rate is 19/min. Nutrition status is not very well, she is thin in first expression. There is no injury or bleeding spots of her skin and mucosa, respiratory sounds in both lungs were normal, there was no dry or moist rales. The cardiac beats was powerful, rhythm is not regular, no obvious murmur in the valves. The abdomen was flat and soft, with no masses or tenderness. Her liver and spleen were normal. There was no edema in both lower limbs. ECG showed: Second degree Atrio-ventricular Block.

Nervous System Examination:
Patient was alert and her spirit was good, clear speech. Her memory and calculation ability were normal, orientation ability is bad. Both pupils were equal in size and round, diameter as 3mm, react well to light stimulus, she can close eyes powerfully. Eyeballs can move freely. Bilateral forehead wrinkle and nasolabial fold are symmetrical, tongue was centered in her mouth, show teeth is normal, soft plate can lift as normal. Pharyngeal reflex is normal, she can turn neck and shrug powerfully, grasp force of left hand is not as well as normal, muscle power of upper limbs is 4+ degree, of lower limbs is 4 degree. The dorsal flexure of left foot was weaker than normal. Muscle tone of 4 limbs is basically normal. There are muscle atrophy in the bilateral forearm muscles, interosseus muscles of both hands, hypothenar muscles, thenar muscles, the distal muscles below the knee joints of both sides. Tendon reflex of upper limbs and lower limbs can not be induced by examination, abdominal reflex of both sides can not be induced, either, the bilateral pathological sign is negative.

Sensory system examination:
Superficial sensitivity: there is 30-40% pinprick sensation hypaesthesia from 5cm above elbow to end of both sides; there is gradually pinprick sensation hypaesthesia from 10cm above knee joint to 20cm below knee joint in the left leg; pinprick sensation loss from 20cm below the left knee joint; there is gradually pinprick sensation hypaesthesia from 10cm above knee joint to ankle in the right leg; pinprick sensation loss from ankle to the toes in the right side.
Topesthesia and shape sensation of 4 limbs are less than normal.
Vibratory sense: 20-30% hypaesthesia below the left wrist; 30% decrease since right metacarpophalangeal joints; gradually hypaesthesia 10cm above the left knee joint; vibratory sensation loss below the left ankle; gradually hypaesthesia below the right knee joint; 50-60% sensation loss in the right ankle area.80% loss of both big toes.vibratory sensation loss of the lateral 3 toes. Finger to nose test of both sides, fingers opposite test, fast alternate movement test are normal. She can perform the Heel-knee-tibia test slowly. When she stood, she had to constantly move steps to keep balance, thus Romberg's sign was positive. Meningeal irritation sign is negative.EMG test (2015, patient did that in another hospital) indicated diffused axon sensory neuropathy.

Treatment:
She received related examinations and diagnosed with1. Hereditary Sensory-Motor Axonalpolyneuropathy 2.Second degree Atrio-ventricular Block.  She received 3 neural stem cell injections and 3 mesenchymal stem cell injections to repair her damaged nerves, replace dead nerves with new injected stem cells, active stem cells in her body, nourish nerves and improve blood circulation, combined with rehabilitation training.

Post-treatment:
After 15 days of treatment, she felt powerful, her right little finger of right hand can move much flexible, and her grasp force of right hand increased, muscle power of upper limbs improved to 5- degree. The dorsal flexure movement range of left foot has improved. Her balance condition was improved. When she stands, she does not need to move steps to keep balance.

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