Lisa-Multiple System Atrophy-(USA)

Name: Lisa
Sex: Female
Nationality: USA
Age: 76Y
Diagnosis: Multiple System Atrophy(MSA) 
Discharge Date: 2018/8/11

Before treatment:
The patient had dizzy spells 2 years ago and her legs became weak after that. She was diagnosed with Parkinsonism and was also found to have cerebellar atrophy and she was then diagnosed with MSA in 2017. She was unable to walk one year ago, her arms could not move well 6 months ago and she also had language and swallowing problems. At present she is lying on a bed, is unable to take care of herself,  is unable to stay in a sitting position and she can only move her forearms slowly. She speaks unclearly, has swallowing problems and can only eat liquid food. She is unable to take care of herself.
Her diet is not good, she sleeps well, she can’t urinate clear at once and she uses medicines for defecation.

Admission PE:
Bp: 150/80mmHg, Hr: 70/min, breathing rate: 19/min. Body temperature: 36 degrees. The patient has poor nutrition status and she was thin. There was no yellow stains or bleeding points of her skin, no pharyngeal hyperemia and no tonsil swelling. The respiratory sounds in both lungs were clear and there was no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was soft with no masses or tenderness. The liver and spleen were normal and there was no edema of her legs

Nervous System Examination:
Patient was alert with dysarthria, weak and slow speech. The memory, calculation and orientation abilities were normal. Both pupils were equal in size and round, diameter of 3 mm, the reaction to light was sensitive, no nystagmus, the eyeballs can move normally and there was poor eye convergence. The bilateral forehead wrinkle and nasolabial fold are symmetrical, she could make her tongue extend out, she had poor tongue muscle movement but no tremor. She could make her tongue extend out  0.5cm from her teeth and the soft palate could lift. She could not turn her head or shrug. The arm proximal side muscle power was 0 degrees, the distal side muscle power was 3+ degrees and the left hand grip force was 3+ degrees. The right hand grip force was 3 degrees. The leg muscle power was 1 degree and the 4 limbs muscle tone was higher than normal. There was cogwheel rigidity when she did passive movement. The bilateral biceps reflex, triceps reflex, radial periosteal reflex were active, the leg patellar tendon reflex and Achilles tendon reflex were normal. Left side Hoffmann and Rossilimo sign were positive, the right side Hoffmann sign was positive and Rossilimo sign was negative. The Babinski sign of both sides were positive. Finger to nose test was normal, the fast alternate movement was clumsy. She could not perform the finger to nose test or heel-knee-tibia test because of weakness. The meningeal irritation sign was negative.

Treatment:
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.     

Post-treatment:
After 13 days treatment her snoring and screaming during the night decreased, her chewing ability got better and she could now take  some small solid food. She could open her mouth much better and  make her tongue extend out to the lip side. The arm muscle power increased, the forearm could now lift up from bed and she could try to touch the 30-40cm high objects. There was mild shrug movement again.