Name: Senado Memun Alberto         
Sex: Male
Country: Mexico
Age: 45 years
Diagnosis: 1.Amyotrophic Lateral Sclerosis(ALS) 2. Colonic carcinoma(postop.)
Date: May 6th, 2015
Days Admitted to Hospital: 15 days

Before treatment:
The patient’s developed left upper limbs weakness without any reason in Aug. 2012, which later spread to his right upper limbs. Both lower limbs were not affected. His disease was progressive. He had speech disturbance in Jan. 2013. He couldn’t walk unless somebody helped him in May 2013. He went to hospital many times but the diagnosis was undetermined. In 2013, he had electromyogram and was diagnosed as Amyotrophic Lateral Sclerosis(ALS). He can’t move out of his bed now, and he can turn over, sit up or sit. He can’t walk or take care of himself. He can’t speak clearly or chew. He can only eat soft food and sometimes he chokes. He wanted a better treatment so he came to our hospital.

His spirit was good. He had lost 30kg since he got the disease. He could sleep well. His urination and defecation were normal. His weight was normal.

Admission PE:
Bp: 145/106mmHg; Hr: 84/min. BT: 36.4 degree, RP: 18/min. He was in good body type and nutrition. The skin and mucosa were normal with no yellow stains or petechia. The tonsil was normal. His thorax was symmetrical. Thorax distensibility was lower than normal. The rate of respiration of both lungs was weak, with no dry or moist rales. Resting degree of periphery blood oxygen saturation was 90-93%. Heart rhythm was normal, with no obvious murmurs, his abdomen was soft, and no pressing pain or rebound tenderness. There were two surgery scars (10 cm) on the upper-middle of abdomen and right side of the navel. The liver and spleen were normal. Both lower limbs were not swollen. The dorsal artery of foot was palpable.

Nervous System Examination:
Senado Memun Alberto was alert and his spirit was good. His speech was unclear, and he had dysarthria. His memory, orientation and calculation ability were normal. The diameter of both pupils was 3.0mms and both pupils were insensitive to direct and indirect light reflex. Both eyeballs had flexible movement without nystagmus. The forehead wrinkle pattern was symmetrical. The nasolabial sulcus was equal in depth. His check blowing was weakness. The tongue was centred in the oral cavity, his tongue could touch the lips, and the muscles of tongue was depauperated, tremulous. His tongue touched the isthmus and pars palatalis weakly. The teeth were symmetrical, his strength to raise soft palate was weak. He had difficulty to swallow, his neck was soft, and the ability to raise head and turn head was weak. His power of shrugging shoulder was weak. The sternocleidomastoid, shoulder girdle muscle, both upper limbs muscle, thenar and hypothenar eminences, interphalangeal muscle and lower limbs muscle were depauperated. The muscle power of abductor, extensor and flexor was at level 2, his grip was at level 1. The muscle power of both lower limbs was at level 2+. Both of his feet couldn’t do dorsiflexion or planter flexion. The muscle tension of both upper limbs was normal, both lower limbs was a little higher. The abdominal reflex was abnormal. The tendon reflex of both upper limbs was abnormal. The patella tendon reflex and ankle reflex of both lower limbs was normal. Both side ankle reflex was negative. Both side palm jaw reflex was positive. Bilateral Rossolimo’s sign was positive. The bilateral Babinski’s sign was negative. The deep and shallow sensation was normal. He couldn’t do the finger-to-nose test, rapid rotation test, finger-to-finger test and heel-knee-tibia test. The meningeal irritation sign was negative.

Treatment:
We diagnosed Senado Memun Alberto based on the history of disease and past examination as: 1. Amyotrophic Lateral Sclerosis, 2. Level 2 hypertension, 3. Colonic carcinoma (postop.). He received consummate examination at the same time he received treatment for improving circulation, nerve nutrition, repairing nerve. He breathed with the help of non-invasive ventilator, and we also gave him daily physical rehabilitation.

Post-treatment:
After the treatment, his condition gradually improved, he felt stronger. He could swallow and had less choke. He could breathe better. Resting degree of periphery blood oxygen saturation was 94-96%. The range of motion of four limbs was greater. The muscle power of both upper limbs was at level 3-, his feet could do dorsiflexion or planter flexion, left foot was better. His treatment is over, he can be discharged.