Kim Hyun Sook-Multiple System Atrophy-(Korea)

Name: Kim Hyun Sook
Sex: Female
Nationality: Korean
Age: 54Y
Diagnosis: Multiple System Atrophy (MSA)
Discharge Date: 2018/08/04

Before treatment:
The patient sweated a lot 2 years ago and she got upset sometimes so she went to hospital and was considered as Parkinson's disease or Multiple System Atrophy. She received treatment to control her condition but her condition got worse. 1 year ago she showed slow movement, balance problems and limb weakness but she can still take care of herself. In the recent 4 months she spoke unclearly and it was easy for her to get tired. At present she has balance problems, orthostatic hypotension, is unable to walk or talk clearly and she in unable to take care of herself at all.
Her diet and sleep are normal, she is unable to control her urination and she also has constipation.

Admission PE:
Bp: 136/86mmHg, Hr: 70/min, body temperature: 36.3 degrees, breathing rate 18/min. There was no injury or bleeding spots of her skin and mucosa, no throat congestion and no tonsil swelling. The respiratory sounds in both lungs were clear with no dry or moist rales. The heart beat was strong with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was soft and flat with no masses or tenderness and there was no edema of the legs.

Nervous System Examination:
Patient was alert, had slurred and slow speech with decreased tone, her comprehension was normal,  short term memory and calculation were below  average. Both pupils were equal in size and round, diameter of 3.0 mm, reacted well to light and the eyeballs could move freely with slight horizontal nystagmus. Bilateral forehead wrinkle and nasolabial groove were symmetrical. She could show her teeth and extend the tongue out as normal. Chewing ability was normal, there was no tongue muscle tremor but her tongue could not move well. The soft palate can be lifted powerfully and the muscle power of neck turning was weak. Binocular convergence was weak. The left arm muscle power was 3+ degrees, grip force was 4 degrees; the right arm muscle power was 3- degrees, grip force was 4- degrees. The left leg muscle power was 4 degrees, the right leg muscle power was 4- degrees. The arm adductor muscle tone was high, the rest were normal. Bilateral biceps reflex, triceps reflex and radial periosteal reflexes were normal. The patellar tendon reflex and achilles tendon reflex were reduced. Bilateral Hoffmann sign was negative, Bilateral Rossilimo sign was positive, Bilateral palm jaw reflections were negative and the  Bilateral Babinski were negative. Finger to finger test, fast alternate movement and finger to nose test were slow, the heel-knee-tibia test was clumsy. The patient's Romberg sign was positive and the meningeal irritation sign was negative. 

After the admission she received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair her damaged nerves, replace dead nerves, nourish nerves, regulate her immune system and improve blood circulation. This was combined with rehabilitation training.     

After 13 days treatment she could stand on her own with eyes closed, her right hand was more flexible, alternate movement of both hands was better, finger to nose test was easier to do than before and her condition was stable. 


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