Amyotrophic lateral sclerosis

Posted By Leon L. Claypool on September 19, 1997 at 22:00:13:









: Patient: Vo Thi Lan - Age: 46 - Sex: Female - Height: 5'5" - Weight: 79 lbs.
I - History of disease:
   Occured 2 years ago with the following symptoms:
   Headache, trembling and little activity of upper and lower limbs, myotonic    dystrophy and muscular twist on the upper limbs and the upper body.     Weakness of upper and lower limbs.  Atrophy of arm and shoulder    muscles, difficulty walking.  Dysphonia and dysphagia.
II - Antecedent of disease:
   Lives in city in Central Vietnam.  Twenty years of teaching in rural area.     Mother has arterial hypertension.  Uncle had cerebrovascular accident.
III - Examination:
   Pulse: 80 to 90 and regular - Temperature 36.5 to 37.2 C - Blood    pressure 130/80 - 140/90mmHg
   1. Nervous system:
      a. Upper limbs:  Regular myotonic dystrophy of uppers limbs, relaxing           muscles, tendon reflex decreased and the following muscular twist           and atrophy - Atrophy of thenar and hypothenar muscles (flat hands).            Atrphy of interphalangeal muscles (two last interphalangeal bones).            Atrophy of wrist flexor muscles (very abductive hands). Atrophy of           shoulder muscles.
      b. Lower limbs:  Regular spasm myotonic dystrophy of the lower limbs.            Rigidity of walking, tendon reflex increased, Babinsky is positive.
      c. Dysphonia and dysphagia.
      d. Normal sensation, no sphincter trouble, no psychiatric trouble.
   2. Other organs: Normal
IV - Diagnosis: Amyotrophic lateral sclerosis.
V - Treatment: Prednisolone, Stugeron, Papaverine, Vitamins, Valium and    Physiotherapy.
VI - Result: No response to therapy, progressively worse.
PLEASE HELP!