Name: Dmitry Shonov
Sex: Male
Country: Russia
Age: 60
Diagnoses: 1.Parkinson's disease 2. lumbar disc herniation 3. Hypothyroidism 4. Hypertension 5. coronary heart disease
Admission Date: October 11, 2012
Days Admitted to Hospital: 25 days

Before treatment:
The patient suffered from tremor of right hand starting 5 years ago, with no incentive. The right had had pill-rolling movement. o he went to a local hospital and was diagnosed with Parkinson's disease. He was hospitalized and received medication to treat the Parkinson's disease, but the patient's condition had no obvious improvement. The disease progress gradually. He had tremor of four limbs accompanied stiffness of the whole body. He had difficulty with strat moving and had weakness of four limbs. He couldn't finish basic living smoothly. In recent 6 months, the patient's codition aggravated further. He couldn��t take care of himself. He also had pain in back and hip joints. His daily life was influenced obviously. Elevation of blood pressure for many times. The laboratory test showed the thyroid function was reduced, the electrocardiogram showed ischemic change.

Admission PE:
Bp: 139/86mmHg; Hr: 90/min. Br: 19 /min. Temperature: 37.3 degree. Inflexional posture. Head forward and trunk flexion. Both elbow joints and hands articulationes digitorum manus were bended, and the right side was more severe. His back arches obviously when he walks. And his body leans forward, presenting festination gait. There was skin mucosal hyperemia in the face and both feet. There was scattered petechia in both feet. Panhidrosis. The respiratory sounds in both lungs were clear, with no signs of dry or moist rales. The heart sounds were strong, A2>P2. The abdomen was smooth and soft. The liver and spleen were not palpable under the ribs. There was no edema in the lower limbs.

Nervous System Examination:
Dmitry was alert. His speech was lack of clear. He spoke slowly and with pauses. The memory, calculation ability and orientation were normal. There was facial masking. Both pupils were equal in size and round. The movement of both eyeballs was flexible and both pupils were sensitive to light stimuli. The convergence ability of the right eye was poor. The rapid blinking ability was poor. The tongue was centered in the oral cavity. There were tremors in the genioglossus. There were obvious tremors in both lower mandibles. The raising ability of the soft palate was normal. Four limbs had static tremor, but the tremors in both upper limbs were more obvious. The shrug muscle strength of shoulders was level 5-, the muscle strength of four limbs was level 5-. He had difficulty with start walk and he walked slowly. His back arched obviously. He had obvious small steps gait when he walked. Four limbs had muscular rigidity. The muscle tone of four limbs was increased. Right hand metacarpophalangeal joints had contracture and present flexion. The bilateral biceps reflex, triceps reflex and radial periosteal reflex were normal. Bilateral patellar tendon reflex and Achilles tendon reflex were slow down. Bilateral abdominal reflexes were weak. The bilateral Hoffmann's sign was negative. The bilateral sucking reflex was positive. The bilateral palm jaw reflex was positive. The bilateral Babinski's sign was positive. Both sides were able to finish the finger-to-nose test and the heel-knee-shin test in a stable manner, but the action was done slowly. There were no signs of meningeal irritation.

Treatment:
Dmitry received treatment from October 11, 2012. He received anti-Parkinson��s medication and had the blood vessels expanded to increase the blood-supply, and he was given nerve nutrition. He also received treatment to get rid of the oxygen free radicals in the brain, administration of thyroxine, stabilize the blood pressure and stabilize cardiac function. This was combined with physical rehabilitation training.

Post-treatment:
The tremor, stiffness and Bradykinesia are alleviated obviously. The patient's back is straighter than before. The gait is better. The facial expression is more natural than before and he has a smiling expression. The limbs are more flexible than before. The tremor of both hands is lleviated obviously. The contracture of right hand metacarpophalangeal joints is alleviated. He can stretch fingers better. The tremor of tongue and mandible are alleviated obviously. The meal time is reduced from 1 hour to 20 minutes. The back pain and packing sensation is alleviated obviously. The hyperaemia of four limbs distal extremities is alleviated obviously. The excessive perspiration of the whole body is alleviated obviously. The dotted petechia of both dorsum pedis are reduced obviously. He is able to finish the finger-to-nose test and rapid rotation test more flexibly. The blood pressute is under control. The recheck of ECG showed the ischemia is not so severe. Thyroid function is to restore it to a normal level.