Name: Simona Nikolova
Sex: Female
Nationality: Macedonian
Age: 25Y
Diagnosis: 1. Ataxia 2. Diabetes(type1)     
Discharge Date: 2018/09/24

Before treatment:
The patient had balance problems in her right side body 15 years ago, her walking position was abnormal and the muscle power in her body became weak. Her condition got worse and worse so a family member took her to hospital and she was diagnosed with ataxia. She was unable to walk many years ago and she used a wheelchair. 4 years ago she was unable to speak clearly or fast and in the recent 2 years her swallowing function and respiration function were weak. At present her balance function is bad, she is unable to sit up, stand up or walk. There is deformity of her fingers and spine and she is unable to take care of herself.
Her spirit, sleep and diet are normal. Her urination and defecation function are normal and she has had diabetes for many years.

Admission PE:
Bp: 137/80mmHg, Hr: 127/min, body temperature: 36.4 degrees. Nutrition status is good and she has obvious scoliosis. There is no injury or bleeding spots of her skin and mucosa, no blausucht and no throat congestion. The respiratory sounds in both lungs were clear and there were no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was flat and soft with no masses or tenderness. The liver and spleen were normal and there was no edema of the legs.

Nervous System Examination:
Patient was alert, she had slurred and slow speech. Her memory,  comprehension and calculation abilities were normal. Both pupils were equal in size and round, diameter of 3 mm, the reaction to light was sensitive, eyeballs can move freely and there was no obvious nystagmus. The bilateral forehead wrinkle and nasolabial fold are symmetrical, she could make tongue extend out normally and she could close her eyes normally. The soft palate could lift powerfully, the uvula was in middle, her tongue could not move with flexibility. Auditory ability was normal and she could turn her head normally and the shrug ability was weak. Her right arm muscle power was 4 degrees, the abductor muscle power was 3+ degrees, the adductor muscle power was 4+ degrees and the right hand grip force was 3+ degrees. Her left arm muscle power was 4+ degrees, abductor muscle power was 4- degrees, adductor muscle power was 4 degrees and the left hand grip force was 4 degrees. Her fingers were bent with malformation and the fingers muscle power were weak. The leg muscle power was 2- degrees, the 4 limbs muscle tone were normal and the 4 limbs tendon reflex could not be induced by examination. The abdomen reflex could not be induced, bilateral sucking reflex, the Hoffmann sign of both sides, the bilateral Rossilimo sign and the palm-jaw reflex were all negative, the Babinski sign of both sides were positive. Her sensory examination was normal. She can perform the finger to nose test in an unstable manner, the fast alternate movement was done slowly, finger opposite movement was difficult, she could not perform the heel-knee-tibia test and she could not sit, stand or walk. 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(Gangliosides and neurotrophic factors), regulate her immune system and improve blood circulation. This was combined with rehabilitation training.     

Post-treatment:
After 14 days treatment her 4 limbs and trunk power improved. She can finish the finger to finger test of both hands and her  fingers flexion improved. Her fingers were less stiff and the finger joints were easier to move. The outreaching strength of the upper arms improved, the muscle strength of her legs increased and she can now lift her legs off the bed. Her balance function was better and she can stand for few seconds with others helping.