Name: Riomal Akachoki              
Sex: Male
Country: Macedonia
Age: 28 years
Diagnosis: Progressive spinal muscular atrophy
Date: Feb. 26th, 2015
Days Admitted to Hospital: 19 days

Before treatment:
He was hard to move his both hands 24 years ago(at the of 3 and half), and his both foot became weak. He often had infection of the respiratory when he was young. He got secondary sex character later than normal. He was fat and got female breast. His testosterone level was lower 5 years ago, after the treatment his weakness became worse. After the rehabilitation exercise, he was better, he could drive. He went to swim 2 months ago and became more weakness. After full examination, he was diagnosed as” spinal muscular atrophy”, the local hospitals couldn’t treat it. He wants to have a better treatment, so he came to our hospital.

He was in good spirit. His eating, urination and excrement were good. His weight was normal.

Admission PE:
Bp: 100/70mmHg; Hr: 80/min, Br: 19/min, temperature: 36.5 degrees. The skin and mucosa were normal, with no yellow stains or petechia. Thoracic symmetry. Mammary development. The respiratory sounds in both lungs were clear, with no dry or moist rales. The heart sounds were strong, the cardiac rate was normal, with no obvious murmur in each valves. The Abdomen was soft without mass. The distal ends of four limbs were smaller. The interosseous muscles of both hands and bilateral gastrocnemius atrophied. The movement of joints were normal. The lower limbs were not deopsical.

Nervous System Examination:
Riomal Akachoki was alert. His calculation ability, orientation and insight were all normal. His speech was clear. Both pupils were equal in size and round, the diameter was 3.0mms. Both pupils were sensitive to light stimulus. Both eyeballs had flexible movement with no nystagmus. His sight and visual field were normal. The tongue was centered in the oral cavity, with no teeth deflection. He could chew and swallow normal. He could shrug his shoulders and turn head powerful. The muscle power of adductor, abductor, extensor, flexor, pronator and supinator were at level 5. The extend and bend muscle power were at level 2, left hand grip was at level 1. The muscle of both thumb was at level 0. The both lower limbs extend hip, bend hip, bend knees was at level 5. The extend muscle power was at level 4. The muscle power of dorsiflexion and planter flexion was at level 2. The muscle tension was lower. The abdominal reflexes and ankle reflex disappeared. Bilateral biceps reflexes, bilateral triceps brachii reflexes, radial periosteal reflex and patella tendon reflex were normal. The cremasteric reflex was delayed. The pathological was normal. The sensory detection and coordinate examination were normal.    

Treatment:
We initially gave Riomal Akachoki a complete examination and diagnosed as “Progressive spinal muscular atrophy”. 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 neurons and to nourish them. We also gave him daily physical rehabilitation.

Post-treatment:
After the treatment, the patient’s weakness was better, the muscle power of right thumb was at level 1, left foot dorsiflexion was at level 2, planter flexion was at level 3-. Right foot dorsiflexion was at level 2+, planter flexion was at level 3.