Kim Joon-seok-Multiple system atrophy-(Korea)

Name: Kim Joon-seok    
Sex: Male
Country: Korea
Age: 52
Diagnoses: 1.Multiple system atrophy 2. hypertension 3 level (very high risk) 3. Renal insufficiency 4. hyperhomocysteinemia 5. hydronephrosis 6. Urinary infection
Admission Date: August 27, 2012

Before treatment:
About 1 year ago, the patient suffered from numbness and weakness of the limbs. He went to the local hospital and received laser therapy in August 2011. But he didn't receive obvious remission from the treatment and the disease worsened gradually. At the same time, he developed a speech disorder and walking problems. He received related rehabilitation as the doctor suggested. The disease progress gradually. The patient received a head MRI and neurologic function examination. The results showed no abnormalities. With the progress of the disease, he, also, had difficulty swallowing and an equilibrium disorder. The local doctor thought he had Parkinson disease and suggested he take Madopar for therapy. The patient took the medication according to the doctor's suggestion. But he suffered from dizziness after standing and fell down. The urinary incontinence was aggravated. The local doctor thought the patient had a definite possibility of multiple system atrophy.

Admission PE:
Supine blood pressure: 162/109mmHg; orthostatic hypotension 156/114mmHg.

Nervous System Examination:
Kim Joon-seok was alert. His facial expression was natural. His speech was not clear and the speed was slow. The memory, orientation and calculation abilities were normal. Both pupils were equal in size and round. The diameter of both pupils was 2.5mms and both pupils were sensitive to light stimulus. The convergent ability of both eyes was poor. The eyeballs could move normally. The forehead wrinkle pattern was symmetrical. The eye close muscle was strong. The nasolabial sulcus was equal in depth. The teeth were shown without deflection. There was no difficulty opening the mouth or swallowing. The mandibular movement was normal. The muscles of the tongue had a slight tremor. The pharyngeal reflex was not elicited. The muscle strength of the right upper limb was level 5, the muscle strength of the left upper limb was level 5-. The hold power of both hands was level 5 and both hands had a slight tremor. The muscle strength of the right lower limb was level 5, the muscle strength of the left lower limb was level 5-. The muscle tone of four limbs was normal. The tendon reflex of both upper limbs was normal. The tendon reflex of both lower limbs was weak. The abdominal reflexes were weak. The sucking reflex was positive. Bilateral palm jaw reflex was positive. Bilateral Hoffdman sign was negative, bilateral Babinski sign was negative. The examinations of the deep and shallow sensation were normal. Bilateral coordinate examination: The patient was able to do the rapid rotation test and digit opposition test, but in a clumsy manner. And the left side was more severe than the right side. He was able to do the finger-to-nose test and the heel-knee-shin test, but in an unstable manner. The walking gait was slow and unstable. The Romberg sign was positive. The neck resistance was negative. The Kerning sign was negative, the Brudzinski sign was negative. From the onset of disease: The patient had a regular diet. There was no nausea or vomiting. He had a cough occasionally when taking a drink. His sleep quality was not good. He had urinary incontinence, but defecation was normal. His weight loss was 4-5kg.

Treatment:
After the admission, Kim Joon-seok received the relevant examinations. He was diagnosed with multiple system atrophy. The patient received treatment to improve the blood circulation, get rid of oxygen free radicals in the brain, and he received nourishment for the neurons. He also received treatment to stabilize cell membrane and stabilize blood pressure. This was combined with physical rehabilitation training.

Post-treatment:

The patient's blood pressure was higher than normal at admission. The repeated measurement results showed the blood pressure surpassed 160/110mmHg. The blood biochemical examination showed the creatinine level is higher than normal. So he is diagnosed with hypertension 3 level, very high risk. He was also diagnosed with chronic renal insufficiency. The ultrasound at admission showed he had hydronephrosis of both kidneys. He suffered from frequency of urination, urgency of urination, dysuria and hematuria while in hospital without cause. The examination showed: urine routine WBC6-8/HP, RBC was filled the field of view Blood 3+, others were normal. Diagnoses: hydronephrosis of both kidneys and urinary infection. After anti-inflammation treatment, remission occurred. At present, the patient has self-control of discharge of urine in the daytime. The blood pressure level is more stable than before. The dizziness, headache and biliousness are alleviated obviously. He is clear-headed. He is able to do the rapid rotation test of both upper limbs and digit opposition test in a more flexible manner. He is able to do the finger-to-nose test more stable than before. He is able to do the rapid rotation test of both lower limbs in a more stable manner. He feels more relaxed when he walks. The balance control ability is better than before when he walks.