Calin Toc-Amyotrophic Lateral Sclerosis(ALS)-(Romanian)

Name: Calin Toc
Gender: Male
Age: 37 years old
Nationality: Romanian
Diagnosis: Amyotrophic Lateral Sclerosis(ALS)

Condition on Admission:
The patient was admitted with a diagnosis of amyotrophic lateral sclerosis, presenting with a 10-month history of progressive dysarthria and dysphagia, as well as left limb weakness for half a year. Ten months ago, he developed unclear speech, choking while drinking and difficulty swallowing without obvious causes, and the symptoms gradually spread to the limbs. At present, he is barely able to speak and can only make sigh-like vocalizations of "ah", with marked weakness in the left limbs. He was diagnosed with amyotrophic lateral sclerosis at a local hospital. He was currently taking neurotrophic supplements, multivitamins and fish oil for treatment.

Physical Examination on Admission:
The patient's heart rate was 64 beats per minute, which easily rised to around 85 beats per minute upon mild activity. His respiratory rate was 18 breaths per minute, blood pressure 119/71 mmHg, and blood oxygen saturation 96%. He was well-developed with a normal body build. No obvious cyanosis was noted on the lips, and the pharynx showed no congestion or swelling. Breath sounds were clear in both lungs, with no dry or moist rales. Heart sounds were strong and regular without audible murmurs. The abdomen was flat and soft, and the liver and spleen were not palpable below the costal margin. No obvious edema was observed in either lower limb.

Neurological Examination:
The patient was alert and appears nervous. He presented with dysarthria. His calculation, memory and orientation were basically normal. The pupils were 3 mm in diameter bilaterally with brisk pupillary light reflexes. Extraocular movements were full and flexible, and no nystagmus was noted. The nasolabial folds and forehead wrinkles were symmetric bilaterally. He had slight difficulty protruding the tongue, accompanied by mild lingual muscular atrophy and slow tongue movement. Air leakage occurred during cheek puffing. The strength of temporalis and masseter muscles was decreased, with marked weakness in mastication and swallowing. Bilateral soft palate elevation was poor, and he experienced occasional choking. Neck rotation and shoulder shrugging were normal. Proximal muscle strength of both upper limbs was Grade 5. Left wrist dorsiflexion and palmar flexion strength were Grade 3+, and left hand grip strength was Grade 3+. Right wrist dorsiflexion and palmar flexion strength as well as right hand grip strength were Grade 5. Interosseous muscle strength was Grade 3- in the left hand and Grade 5 in the right hand. Muscle strength of the left lower limb was Grade 4-; the patient struggles more when bending and supporting the left leg, with poor resistance against external force. The right lower limb muscle strength was Grade 5. Muscle tone of all limbs was roughly normal, and superficial sensation was intact throughout the extremities. Bilateral tendon reflexes were mildly diminished. Pathological reflex was positive in the right lower limb. The bilateral finger-to-nose tests were performed fairly well. The left finger-to-finger test was clumsy, and the little finger failed to oppose normally, while the right side was unremarkable. The left rapid alternating movement test showed clumsiness, and the right side was normal. The left heel-to-shin test was clumsy, and the right one was basically normal. Meningeal irritation signs were negative.

Treatment Process:
The patient was diagnosed with amyotrophic lateral sclerosis upon admission. During hospitalization, neural stem cells were administered to repair motor nerve damage, and mesenchymal stem cells were used to provide support for neurotrophy, endocrine function and immune regulation. Adjuvant CAST therapy was implemented with edaravone, neurotrophic factors, monosialotetrahexosylganglioside and reduced glutathione, in combination with comprehensive rehabilitation therapy.

Post-Treatment Outcome:
The patient's motor function is improved significantly, and his articulation is greatly enhanced. He can count from 1 to 20 and pronounce short words with clear and intelligible voice. His swallowing function also shows mild improvement. The muscle strength of the left upper limb is increased. Left wrist dorsiflexion and palmar flexion strength as well as left hand grip strength recovers to Grade 5-. The left hand can resist strong force during finger opposition, except for the little finger. The muscle strength of the left lower limb is further improved to nearly Grade 5. He can bend his left leg to support his body for more than 15 seconds and maintain the posture against resistance afterwards. His exercise tolerance is elevated, and his heart rate is increased less obviously after activities. His mental state also gets better. He becomes more positive and smiled more frequently.