Name: Albahrani Amnah Hussain M.
Sex: Female
Country: Saudi Arabia
Age: 65
Diagnoses: 1.Parkinson's disease 2.hypertension, level-2 (very high risk)
3. Hyperlipidemia
Admission Date: 2011-09-06
Days Admitted to the Hospital: 29

Albahrani first developed tremors in the right arm, without an obvious cause, 10 years ago. She also had some difficulties with her balance, but didn't seek treatment at the time and soon after she started having tremors in the left arm. Her movements were slow as well. Albahrani began getting treatment for these symptoms and Parkinson's disease was considered. About 5 years ago, she developed problems with her speech and her arms and legs became stiff and weak. The symptoms gradually became worse and the diagnosis of Parkinson's disease was confirmed. She was put on medication for the symptoms with some positive results, but the overall progress of the disease was not stopped and eventually her posture and gait became abnormal. With the anti-Parkinson's medication, the symptoms were temporarily alleviated. But about 3 years ago, she developed swallowing difficulty, lower back pain and general weakness. Eventually she was unable to stand or walk and had to remain in bed. After she took her medication, she was able to turn over in bed by herself. She could also feed herself but was not able to completely take care of herself.

Throughout the nervous system examination, Albahrani was alert, but her speech was not clear. Her facial expressions were limited. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and round, the diameter was about 2.5mms. The movement of both eyeballs was flexible and both pupils were sensitive to light stimuli. She had to breathe with her mouth open. The teeth were shown without deflection and the tongue was centered in the oral cavity. There were tremors in the muscles of the tongue. She had difficulty with swallowing and would cough when she drank water. The muscles that raise the soft palate were weak. The body had weak turning ability and the muscle strength was weak. The shoulder muscles had weak shrugging ability. The muscle strength of the upper limbs was level 4. The grasping strength of both hands was level 4. The muscle strength of the lower limbs was level 2+. The muscle tone of all four limbs was normal. Albahrani was unable to stand or walk. There was difficulty with starting her movements and the movements were slow. The fine motor skills of the hands were poor. The tendon reflexes of all four limbs were not elicited. The bilateral Hoffmann's sign was positive. The bilateral palm jaw reflex was positive. The sucking reflex was positive. The bilateral Babinski's sign was negative. There was almost normal fine, deep, and shallow sensation. The bilateral finger-to-nose test was not stable. She was able to complete the rapid rotation test and the digital opposition test slowly. She could complete the heel-knee-shin test, but had difficulty with the Romberg's test.

Albahrani received all of the relevant examinations. She received anti-Parkinson's medication and had the oxygen free radicals eliminated. She was also given treatment in order to expand the blood vessels, nourishment for the neurons and had her blood pressure brought under control. This was combined with physical rehabilitation training and language training. 

After the completion of the treatment, Albahrani's condition had improved. Her mental outlook is better than before. The treatment adherence is better. The sleep time is more regular. The abdominal distension has been almost completely alleviated. She is able to begin her movements easier now and the reactions are quicker than before. The speech is clearer now. The eating ability is better and there is no more upset stomach. The swallowing difficulty has been alleviated. The facial expressions are now more natural. The tremors in the tongue and in both arms have been alleviated. The slow actions of, turning over, sitting up, walking and changing directions have become quicker than before. The fine movements of the fingers are more flexible. The muscle strength of the legs has increased, and has reached level 4-. She can walk several meters without support, and the distance of the strides has increased. The posture and walking gait abnormalities have disappeared. She still needs some assistance when walking through a narrow place. The balancing ability has improved noticeably.