Mohammed AlBahrani-Dementia-(Saudi Arabia)

Name: Mohammed AlBahrani                 
Sex: Male
Country: Saudi Arabia
Age: 72
Diagnoses:
1. Dementia (severe) 2. Dysfunction of hypothalamic-pituitary, metabolic alkalosis, thyroid hypofunction 3. Lung infection, Type 2 respiratory failure 4. Myocardial ischemia, cardiac insufficiency 5. Hypertension level 2 very high risk 6. Type 2 diabetes 7. Gastrointestinal function failure 8. Bed sore 9.  Liver dysfunction 10. Hyperhomocysteinemia 11. Posted operation of hydrocephalus

Before treatment:
The patient could fall down easily when he walks 5 years ago. He also had Urinary incontinence and memory loss. He was diagnosed with normal pressure hydroencephalus. He received symptomatic treatment but the effect was not good. His disease aggravated gradually, this was accompanied with drops in social ability. The patient received cerebrospinal fluid shunt 3 years ago. His condition had no improvement. About 1 year ago, the patient fell down and his four limbs lost movement function. His language from allophasis to speechless. There was a large area bed sore. At present, the patient is kept in bed, indwelling gastric tube and indwelling urine apparatus. His blood pressure and blood sugar have improved. He also had breathing difficulty. He had no familial hereditary disease.

Admission PE:
Bp: 149/96mmHg; Hr: 75/min, temperature 36.9 deg. Br: 25/min. Breathing activity was poor.  The respiratory sounds in both lungs were weak, with moist rales and phlegm sound. The rhythm of his heartbeat was normal, with level 2 blowing murmur in mitral valve systole. His abdomen was enlarged and soft, with no pressing pain or rebound tenderness in the abdomen.  The doctor did not touch the liver or spleen under the ribs. The liver and spleen were not enlarged. There was cerebrospinal fluid shunt tube in subcutaneous. There was no swelling in both lower limbs. There was a bedsore, size about 15cm*10cm. The surface of a wound was presented light red. There was flask-shaped sinus tract. The inner surface of wound was dark red. Bilateral femoral head had old bed sore.

Nervous System Examination:
Mohammed AlBahrani was sleepiness, and was in weak spirits. He had indifferent expression and he had slow response. He couldnt express himself. His memory was declining. His calculation abilities, insight and orientation were poor. Both pupils were equal in size, the diameter was 2.5mms. The eyes movement was limited. His pupils reacted sensitive to light stimulus. The forehead wrinkle pattern was symmetrical. He was able to close his eyes with ease. The bilateral nasolabial sulcus was equal in depth. The tongue was at the center of oral cavity and the tongue could be lifted with strong muscle. He had strong muscle to raise soft palate. His left limbs had no movement and right limbs had movements. The muscle tone of four his limbs was higher than normal. The tendon reflex of both upper limbs was normal. Bilateral patellar tendon reflex was not elicited. Bilateral Achilles tendon reflex was not elicited. The abdominal reflex was negative. Bilateral Hoffmman sign and Rossilimo sign were negative. Bilateral palm jaw reflex were negative. Bilateral Babinski sign was negative. He couldn't cooperate with the coordination movement examination. He couldn't cooperate with the examination of deep sensation or shallow sensation. There were no signs of meningeal irritation. The test of blood gas analysis showed type 2 respiratory failure and metabolic alkalosis. The blood sugar level was higher than normal. Thyroid function was reduced. HCY level was higher than normal. ECG showed myocardial ischemia.

Treatment:
We initially gave Mohammed AlBahrani a complete examination. He received treatment to improve his blood circulation in order to increase the blood supply to the damaged neurons, nerve regeneration and to nourish them. He also received treatment to anti-infection, control his blood pressure, blood sugar, to improve liver function, debridement and wound dressing. This was accompanied by daily physical rehabilitation training.

Post treatment:
The degree of awakening has improved. His speech function is better than before, he has communication with family members and the communication is increased. The activity of his left limbs has been restored to normal. His four limbs has more autonomic activities. His blood pressure and blood sugar are under control. His cardiac murmur has been alleviated. Thyroid function has restore to normal. There is still level 1 blowing murmur present in mitral valve area systole. Thyroid function is restored to normal level. The liver function is better than before. The metabolic alkalosis has been cured. The potassium deficiency also has been cured. Gastrointestinal function is better than before. There is a bed sore in the sacrococcygeal region, the size is about 2cm*2cm. The surface of the wound is light red. The sinus tract is better than before. There is new granulation tissue formed. The patient's blood pressure was over 150/100mmHg for many times at the time of admission, after adjusting the medication, the patient's blood pressure is restore to normal level gradually. FBG at the admission was 8mmol/L, postprandial blood sugar was 11mmol/L.  After adjusting his diet and medication, the patient's FBG was 4.3-6.0mmol/L, postprandial blood sugar 6.7-9.4mmol/L.