Peter-Multiple system atrophy-(USA)

Name: Peter
Sex: Male
Nationality: USA
Age: 70
Diagnoses: 1. Multiple system atrophy (MSA) 2. Upper respiratory tract infection Date of Admission: Jan.26, 2016
Treatment hospital/period: Wu Medical Center/14 days

Before treatment:
Six years ago, Peter developed weakness in the lower limbs, and his movements were slow. His memory started to decline. Four years ago, he had difficulty swallowing, frequency of urination and difficulty urinating. These symptoms were aggravated. Three years ago, he was diagnosed with multiple system atrophy at the local hospital, and he was prescribed Sining, but the medication was ineffective and the symptoms were still aggravated. Before Peter was hospitalized, he had slow movement, poor balance, and was unable to stand up. He also had difficulties in turning over and sitting up unassisted. Peter was unable to care for himself. He can eat, brush his teeth and wash his face slowly. But he has difficulties in swallowing and has to eat soft food, and easily chokes when drinking. Peter’s speech is unclear and it will be aggravated when he is fatigued. He lost his appetite after the onset of the disease and he became depressed and didn’t get adequate sleep. Every day, Peter will sleep over four to five hours and urinates frequently and is also constipated.

Admission PE:
Bp: 137/80mmHg, Hr: 88/min, there was no yellow stains on the skin or mucous membranes, there was a big patch of petechia on his right ankle, there was no bleed spot or petechia on the other parts of the body. There was no obvious throat congestion. There was some white sputum. The size of the tonsils was normal. The respiratory sounds in both lungs were lower than normal. There were no dry or moist rales. The heart sounds were strong. The cardiac rhythm was regular, with no obvious murmur in the valves. The abdomen was flat and soft, with no masses or tenderness. The doctor didn’t examine the enclosed mass on the abdomen. There was pitting edema on the ankles. The skin temperature of the feet was normal. 

Nervous System Examination:
Peter was alert, his facial expressions were normal, he was not able to speak clearly, but the speed was normal. There were lags in his responses. His short-term memory was bad, but his orientation and calculation ability were normal. Both pupils were equal in size and round, the diameter was 2.5mm. Both pupils were sensitive to light stimulus. The eyeballs could move flexibly. The forehead wrinkle pattern was symmetrical. Peter was able to close his eyes strongly. The bilateral nasolabial sulcus was equal in depth. The mouth and teeth were in the right position without deflexion. He was able to open his mouth normally, and eat and chew food normally. Peter ate mostly soft food and he ate slowly. The lower jaw movement was normal. The tongue muscle was normal but it was difficult for the tongue to extend to the inside of the cheeks. There was leakage of air when the cheeks were expanded. The muscle power of both upper limbs was at level 5 without the wax-waning sign or static tremors. There were intentional tremors in the upper limbs. It was hard for him to write. The muscle power of both lower limbs was at level 4, he was not able to stand up by himself He was able to turn over and sit up slowly. He walked slowly indoors with the help of an ambulation aid, but he needed to use a wheelchair outdoors. The muscle tension of both upper limbs was normal; it was a little higher than the lower limbs. He was not able to move his hip joints very well. The tendon reflex of both upper limbs was over active, the patella tendon reflex and Achilles reflex were abnormal. The abdominal reflex was abnormal. The sucking reflex was negative, the palm jaw reflex and Hoffman’s sign were positive. The Babinski’s sign was weak negative. The deep sensation and superficial sensation were normal. Peter was able to do the finger-to-nose test, but he had difficulty with it. He did the rapid rotation test slowly. The heel-knee-tibia test was uncoordinated. He was not able to move his upper limbs well, he needed someone to help him when he put on clothes and took a shower. He was able to eat, drink, brush his teeth and wash his face by himself but slowly. The neck rigidity was negative. The Kernings’ sign was negative. The Brudzinski’s sign was negative.

Treatment:
After Peter was hospitalized, he was diagnosed with multiple system atrophy and respiratory system infection. He was given three NSC injections and three MSC injections to initiate the repairing and replacement of the nerves. The stem cells in his body were activated to improve the nutrition, and circulation. The immune system was strengthened to resist infection. He needed non-invasive respiratory assistance. He was given physical rehabilitation training.

Post-treatment:
After two weeks of treatment, Peter’s respiratory functioning had improved, the blood and Sat was promoted to 93-97%. Peter’s swallowing ability has improved. The time required to eat food has decreased. The bucking has been reduced; the amount of saliva has been reduced. Peter’s pronunciation is clearer as compared to before the treatment. The energy and physical condition has improved and the sleeping time has been extended to six or seven hours. The strength of the limbs has increased, the muscle force has been restored to 5-, and the movement flexibility has improved. The time required for turning over, sitting up unassisted, dressing and grooming has decreased. Peter’s balance has improved and he can now stand up unassisted between 5 and 10 seconds.