Krauchuk Aliaksandr-Sequelae of Spinal Cord Injury-(Belarus)-2nd round

Patient Name: Krauchuk Aliaksandr
Gender: Male
Age: 36 years old
Nationality: Belarus
Diagnosis: Sequelae of Spinal Cord Injury

Pre-treatment:
The patient was admitted to hospital with the primary complaint of "dyskinesia of all four limbs for 9 years after cervical trauma", diagnosed as sequelae of spinal cord injury.

Admission Physical Examination:
The patient's blood pressure was 127/57 mmHg, heart rate 57 beats per minute, respiratory rate 18 breaths per minute. The patient had moderate nutritional status. Bilateral lung breath sounds were clear without rales. Heart sounds were forceful with regular rhythm, and no murmurs were heard over each valvular area. The abdomen was flat and soft, with no hepatosplenomegaly. There was no edema in both lower limbs.

Neurological Examination:
The patient was conscious and spoke fluently. His memory, calculation and orientation were normal. No abnormalities were found in cranial nerve examination. The neck was soft, and the muscle strength for neck rotation and shoulder shrugging was acceptable. Proximal muscle strength of both upper arms was roughly grade 5, distal muscle strength roughly grade 4; left wrist muscle strength was grade 2+, left hand grip strength grade 2+; right wrist muscle strength grade 3-, right hand grip strength grade 2+. Lumbar and dorsal muscle strength was grade 2-. Muscle strength of both lower limbs and feet was grade 1. Muscle tone of both upper limbs was approximately normal, while muscle tone of both lower limbs was slightly elevated. The thenar, hypothenar and interosseous muscles of both hands as well as bilateral arm muscles were fuller than those during the last admission; moderate muscular atrophy was observed in bilateral leg muscles. Tendon reflexes of both upper limbs were basically normal; tendon reflexes of both lower limbs were hyperactive, accompanied by obvious associated facial reactions and severe discomfort in lower extremities. Clonus could be occasionally seen in bilateral lower limbs, yet less frequently compared with the previous admission. The bilateral superficial and deep sensory levels had improved compared with before. Superficial and deep sensations were diminished below the bilateral T3 segment, most prominent in the feet. Bilateral pathological signs were negative. Bilateral finger-to-nose test and alternating movement test showed clumsy movements. Bilateral finger opposition test and lower limb coordination tests could not be completed due to insufficient muscle strength. Meningeal irritation signs were negative.

Treatment Process:
A definite admission diagnosis of sequelae of spinal cord injury was made for the patient. The patient received spinal nerve repair therapy with neural stem cells and mesenchymal stem cells, supplemented by CAST therapy to improve blood circulation, nourish nerves and regulate immunity, along with comprehensive rehabilitation therapy.

Post-treatment:
The patient's motor function has improved. Left wrist muscle strength reaches grade 3, left hand grip strength grade 3; right wrist muscle strength grade 3+, right hand grip strength grade 3. He can basically grasp other people’s fingers and bear resistance with both hands, and both wrists can resist mild resistance. Lumbar and dorsal muscle strength rises to grade 2+. Muscle strength of bilateral lower limbs improves to grade 2 with preliminary weight-bearing standing capacity. He can maintain weight-bearing standing for about 3 seconds when holding a walker with both hands. Clonus of bilateral lower limbs is markedly relieved, and associated facial reactions almost disappear when tapping the upper and lower patellar regions with a percussion hammer. Bilateral abdominal reflexes can be elicited. The level of diminished superficial sensation descends, and the sensitivity of superficial and deep sensations in the back, chest wall, legs and toes is enhanced compared with the pre-treatment state.