Name:Joseph

Sex:Male

Age:43 years old

Country: Indonesia

Diagnosis: Multiple system atrophy (MSA)

Admission Date: 2013-12-02

Days Admitted to the Hospital:28

Before treatment:

The patient suffered from ataxia without obvious inducement. He walked unstable and had difficulty with writing. He also had postural hypotension, urgency to urinate and articulation disorders. After he received multi-test laboratory examination, he was diagnosed with multiple system atrophy. He didn't receive treatment. About 6 months ago, the patient's disease aggravated in varying degrees gradually. From the onset of disease, the patient had normal spirit. His diet and sleep quality was normal. He had urinary urgency. He had normal defecation. The weight had no obvious change.

Admission PE:

Supine blood pressure: 123/85mmHg; The standing blood pressure: 74/59mmHg. He had normal body type. The skin and mucous showed no obvious abnormalities. The thorax had no abnormalities. The respiratory sounds in both lungs were unclear. The heart sound was low, the cardiac rhythm was regular. The abdomen was soft. The liver and spleen were not touched under the ribs. There was no edema in the lower limbs.

Nervous System Examination:

Joseph was alert. The speech speed was normal. Sometimes, his pronunciation was not clear. He walks unstably, with cerebellar gait. The step was the same wide with shoulders. There were no swing arms. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and round. The diameter of both pupils was 3.0mms and both pupils were sensitive to light stimulus. Both eyeballs could move freely. There was no obvious nystagmus. There was no diplopia. He was able to close his eyes with ease. The corner of mouth was symmetry and the tongue was almost in the center of oral cavity. He could raise his soft palate symmetrically. The muscle strength to swivel and shrug shoulders was strong. The muscle strength of his four limbs was at level 5. The muscle tone of his four limbs was almost normal. The tendon reflex of his four limbs was active. The Cremasteric reflex was delay. The erection of his penis was reduced obviously. Bilateral abdominal reflexes were elicited. The examination of the sensory system was almost normal. Bilateral palm jaw reflex was negative. Bilateral Rossilimo sign and Babinski sign were negative. The patient did rotation test and digital opposition test awkwardly. He did the finger-to-nose test in an unstable manner. He did bilateral heel-knee-shin test unstably. The right side was more severe. The Romberg sign was positive. He had obvious topple and fall tendency to left side and right side. The meningeal irritation was negative. The MRI (2012.12.3) of the head showed: there was atrophy of epencephal, mesocephalon and medulla oblongata. The pressure differential in lying position and upright position was 30-50mmHg. Sometimes, he had dizziness.

Treatment:

The patient received treatment from December 2, 2013. The patient received nerve regeneration treatment and stem cell activating treatment. At the same time, he received treatment to improve the blood circulation, nourish his neurons and also to regulate his blood pressure. This was combined with massage therapy around his eyes.

Post Treatment:

After treatment, the pressure difference in lying position and upright position was 6-30mmHg. The dizziness is relief and frequency of urination has disappeared. The urinary urgency is alleviated. The penile erection is better than before. Bilateral rotation test and digital opposition test are more flexible than before. He does the finger-to-nose test and the heel-knee-shin test more stable. For the Romberg sign test, he did better than before. He has better balance ability when he walks.