Name: Keith Miner              

Sex: Male

Country: USA

Age:31 years

Diagnosis: Amyotrophic Lateral Sclerosis

Date:May 15, 2014

Days Admitted to Hospital: 14 days

Before treatment:

The patient suffered from muscle atrophy of his left hand 4 years ago. He also suffered from muscle tone reduction. With the progression of the disease, the patient's right hand and both upper limbs suffered from muscle atrophy and muscle tone reduction. He was diagnosed with Amyotrophic Lateral Sclerosis 3 years ago. At the same time, the patient suffered from speech disorders and swallow difficulty. Both lower limbs suffered from weakness of the lower limbs. He was always falling down and walks slowly. The muscle strength for breath was weak. The muscle tone of both lower limbs was higher than normal. He took Baclofen for treatment. Sometimes, he experiences pain from the whole body. He took analgesic drug and the disease progressed gradually.

From the onset of disease, the patient had normal spirit. Before the treatment, the patient had difficulty with swallowing. The sleep quality was poor. The defecation and urine was normal. There was no family or genetic disease.

Admission PE:

Bp: 120/70mmHg; Hr: 76/min, temperature 36.1 deg. Br: 20 /min. The breathing movement of both lungs was weak. The respiration of both lungs was clear. The respiration of both lungs' bottom was weak, with no obvious rales. The heart rate was regular, with no obvious murmur. The abdomen was flat and soft, with no pressing pain or rebound tenderness. The liver and spleen were impalpable under the ribs. There was no edema in both lower limbs.

Nervous System Examination:

Keith Miner was alert and his spirits was okay. The patient's speech was unclear, sometimes he needed to repeat the language then a person could hear. Examination of the memory, calculation abilities and orientation of the patient were normal. Both pupils were equal in size and round. The diameter was 3.0mms. Both eyeballs had normal movement and the pupils had normal reactions to light stimuli. Both eyeballs could move freely. The forehead wrinkle pattern was symmetrical. The eye closing ability was strong. The bilateral nasolabial sulcus was equal in depth. He had weak muscle to drum cheeks. The tongue was at the center of oral cavity. The tongue could reach teeth. There was mild atrophy in the tongue. The movement of tongue was not flexible. The teeth were shown without deflection. Both side could raise soft palates and the muscle strength was weak. He had difficulty with swallowing. The neck was soft. He had strong muscle to raise and turn head. The muscle strength to shrug his shoulders was at level 4. There was muscle atrophy in both upper limbs. The muscle strength of both upper limbs' far end was at level 3 and the near end was at level 2. The muscle strength of both lower limbs was at level 4-. The muscle stone of both upper limbs was low. The muscle tone of both lower limbs was higher than normal. The tendon reflex of his four limbs and the abdominal reflexes were elicited. Both lower limbs had tendon hyperreflexia. Bilateral ankle clonus was positive. Bilateral palm jaw reflex was positive. The sucking reflex was negative. Bilateral Hoffmann sign was positive. Bilateral Rossilimo sign was positive. Bilateral Babinski sign was positive. There was normal deep sensation and shallow sensation through the coarse scale. He was unable to finish the finger-to-nose test, the rapid rotation test and digital opposition test. He did the Heel-knee-shin test in a stable manner. There were no signs of meningeal irritation.  Assistant examination: EMG: four limbs had neurogenic lesions. MND was considered.

Treatment:

We initially gave Keith Miner a complete examination. According to his medical history and examination, the patient was diagnosed with amyotrophic lateral sclerosis. He received treatment for nerve regeneration and to activate stem cells in the body. He received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves and to nourish the neurons. He was put on non-invasive mechanical ventilation to breathe. This was combined with daily physical rehabilitation training.

Post-treatment

Keith Miner's condition has improved gradually. The speech is clearer than before. The excessive salivation has reduced than before. His breathing is better than before. The expansion of thorax has improved and the expansion ratio has reached 1.5cm. The respiratory sounds in both lungs' bottom are better than before in horizontal position. The muscle strength of his neck and both upper limbs is better than before. The movement of all the fingers are more flexible. The muscle pain and muscle tonus are alleviated than before (the medication which is taken by himself has reduced than before, Baclofen 5mg,bid, Oxycodone & Acetaminophen 10/325mg q12h).