Hobart Kashmir Khilj-Spinal cord injury-(Afghanistan)-Posted on Feb.5th, 2015

Name: Hobart Kashmir Khilj                 
Sex: Male
Country: Afghanistan
Age: 50 years
Diagnosis: 1. Spinal cord injury 2.  Urinary infection
Date: Jan. 9, 2015
Days Admitted to Hospital: 21 days

Before treatment:
      Hobart Kashmir Khilj fell from a large vehicle 4 months ago (13th Sept. 2014) and at the time before his fall, he was consciousness. He lost his motor sensation below his chest and was sent to the hospital in time. He was diagnosed with Spinal cord injury and had a surgery that day. Three days later, he began to have rehabilitation exercise. His upper limbs could move, but with movement restriction. Both of his lower limbs couldn’t move normal. He wants to have a better treatment, so he came to our hospital and he was diagnosed with spinal cord injury.
      He was in good spirit, his weight was stable, his diet was normal, but he was no having a good sleep. He had urine incontinence (retention catheterization) and defecates (once a day).

Admission PE:
      Bp: 13/83Hg; Hr: 67n. He was well nourished. There was no yellow stain or petechia on mucous membrane. There were two to III degree empyrosis scar near the end of left lower limb. The size was 2cm*5cm and 4cm*7cm. The wounded areas were clean and dry. There was no congestion in pharyngeal. The tonsil was not enlarged. The thorax was symmetrical. No breathing difficulty. The respiratory sounds in both lungs were clear, with no obvious moist or dry rales. The heart sounds was strong, the rhythm of his heartbeat was normal. There was no obvious murmur in the valves. The abdomen was flat and soft, with no pressing pain or rebound tenderness. The liver or spleen was normal. The temperature of both feet was lower. The artery pulse was strong in both dorsum of foot. There were pitting edemas in both lower limbs ankle bone. His spine was a little bent to right. The leucocytes were all over the vision under the routine urine test.

Nervous System Examination:
      Hobart Kashmir Khilj was alert and his speech was fluent. His memory, calculation and orientation abilities were normal. Both pupils were equal in size and round, the diameter was 2.5 mms, both eyeballs could move freely. Both eyes had sensitive response to light stimuli. The forehead wrinkle pattern was symmetrical. The tongue was centered in the oral cavity and the teeth were shown without deflection. The neck moved almost normal. The muscle strength to shrug shoulders was strong. The muscle power of adductors, abductors, pronators, supinators and flexors of both upper limbs was at level 4.  The muscle power of left extensor muscle and grip strength was at between levels 2-3. His left hand could extend about 90%, his right hand could extend about 50%. The right extensor muscle power was at level 1+. Grip strength was at level 0-1, the shape was gripping. The flexor muscle power of both upper limbs distal ends was at level 1-2. Both lower limbs was at level 0. The muscle tension of four limbs was normal. The reflex of both side’s biceps brachiis and radial periosteal were active. Abdominal reflexes of both sides, left side patella tendon reflex disappeared and right side patella tendon reflex were normal. Both sides achilles reflex were normal. The depth feeling under T3 and both upper limbs were declined. Bilateral Babinski sign was positive. The examination of coordinate movement of both upper limbs was almost normal and lower limbs couldn’t be examined.

Treatment: 
      Then we proceeded with the treatment to nourish his nerves and improve the blood circulation to increase the blood supply to the damaged neurons. He also received treatment to activate his own neural cells. This was combined with daily physical rehabilitation training.

Post-treatment:
      The size of empyrosis was smaller. It was 1cm*3cm and 3cm*4cm. The depth feeling plane was lower to T11-12. The abducent muscles power of right upper limbs improved to level 3-, and the left improved to level 3-4. The end of his right hand finger could bend and his big toe could act as a go between, the muscle power was at level 2-, the grip power of left hand was at level 3. The involuntary myospasm of both lower limbs were decreased, the muscle power at the proximal end of both lower limb was at level 2-. There was muscular contraction at distal end of left limb. The lower limb had translation itself. The urinary tract infection was treated, routine urine test recheck: leucocyte 0-1/P.The treatment plan have been completed, the discharge has been permitted.