Name: Esther
Sex: Female
Country: Saudi Arabia
Age: 38 years
Diagnoses: 1. Sequelae of spinal cord injury 2. Hyperlipoidemia
3. Thyroid hypofunction
Admission Date: 2013-05-06
Days Admitted to the Hospital: 36

Medical History:
The patient suffered an injury from a car accident in March 2008. She suffered from a coma and was sent to hospital quickly. She was diagnosed with subluxation of metastethidium T11/T12 post trauma and T2 spinal cord contusion. She received an operation and tracheotomy CPAP assistant respiration. After the operation, the patient was still in a coma. She suffered from septicemia during the hospital stay. After treatment, the patient's condition improved. The patient come around 1 month later and breathes by herself. The patient had normal memory, calculation abilities and orientation. Her speech and swallow ability were normal. The motor ability and sensation of both upper limbs were normal. The motor and sensation of both lower limbs was lost completely. The patient received T10-L1 laminectomy and autologous stem cell implantation in Germany in 2010. But the patient's neurological function had no improvement after treatment. Then the patient received stem cells therapy three times in one hospital in Beijing, but the neurological function had no improvement too. The patient suffered from pain in bilateral hip joints and thigh outside. The sensation of both lower limbs was lost completely. She also had urinary and fecal incontinence. She was unable to take care of herself completely.

Nervous System Examination:
Esther was alert and she was in good spirits. Her speech was clear. Her memory, calculation abilities and orientation were all normal. Both pupils were equal in size and the diameter was 3.0mms. Both eyeballs could move freely and the pupils reacted normally to light stimulus. The forehead wrinkle pattern was symmetrical. The tongue was centered in the oral cavity and the teeth were shown without deflection. The neck had flexible movement. The muscle strength of both shoulders to shrug was strong. The muscle strength of both upper limbs was level 5. The muscle tone of both upper limbs was normal. The muscle strength of both of the lower limbs was level 0. The muscle tone of both of the lower limbs was higher than normal. She had difficulty with passive movement. The tendon reflex of both upper limbs was normal. The tendon reflex of both lower limbs was active. Bilateral abdominal reflex was disappeared. The deep sensation below thoracic vertebra below thoracic vertebral 11 was lost completely. Bilateral Hoffmann sign was negative. Bilateral palm jaw reflex was negative. The sucking reflex was negative. Bilateral Babinski sign was positive. The meningeal irritation sign was negative. The patient was able to finish the finger-nose-test and the rapid rotation test. She was unable to finish the heel-knee-tibia test.

Treatment:
Esther received treatment from May 6, 2013. We proceeded with the nerve nutrition, regulate blood lipids and improved the blood circulation to increase the blood supply to the damaged neurons. She also received treat for nerve regeneration and add a few thyroid hormones. This was combined with daily physical rehabilitation training.

Post-treatment:
The patient's neurological function has significant improvement. The plane of temperature sensation and pain sensation are reduced from thoracic vertebral 11 to L1 spinal segment. The muscle tone of both lower limbs is reduced. She can do passive exercises more easy. Both lower limbs had active movement. The muscle strength of both lower limbs' near-end are increased to level 2+. In supine position, when the patient bends one side hip and knee, she can lift another lower limb. Before discharge: the recheck of blood lipid and thyroid gland are almost normal.