1. February 27, 2010
Patient: Ghiath Hubbi
Age: 51 yrs
Case Summary:
Mr. Hubbi presented in August 2009 with Hoarseness/dysphonia accompanied by
paroxysmal cough and slight shortness of breath. This was accompanied by weakness in
jaw muscles, mild paresis of mouth muscles (difficult to kiss), muscle spasms in left arm,
weakness in left hand. Wife also noticed emotional lability. Prior to these symptoms,
patient was suffering from gastro-esophageal reflux which improved with antacids and
anti-depressants.
Within 3 months, the voice was almost lost completely with increasing shortness of
breath and acute choking incidents. Muscle spasms (fasciculation) spread throughout
body and slight atrophy of affected muscles was noted.
In January 2010, patient was admitted and a Tracheostomy was performed. Intense
persistent cough episodes in days after procedure produced through the trach opening, a
thick mucus segment of approximately 6cm in length. This resulted in instant
improvement of dysphonia/ voice audibility as well as relief in shortness of breath.
Tests: CT Scan of neck and sinuses performed in October showed deviation of left vocal
chord toward midline without obvious mass, and Gross enlargement of nasal concha and
an obscure left maxillary sinus.
All other tests/procedures were within normal (MRI of Head/Neck, Spinal Tap, Chest CT
Scan, Chest X-Rays, blood work.)
Note of interest: 2 years prior to onset of symptoms (in August 2007), patient had
suffered an acute sinusitis incident following prolonged use of paint thinner for cleaning.
The patient had not taken any protective measures such as a mask and proper ventilation,
etc.., while using the thinner. The hoarseness began to develop immediately after this
infection.
Since Tracheostomy, the following improvements have been noted:
- Ability to expel sputum through mouth.
- BP returned to normal.
- Voice is clearer and markedly more audible.
- Improvement of jaw paresis
- Significant decrease of muscle spasms. Increasing only with cough episodes.
- Ability to breath upon closure of trach opening.
- No more choking incidents.
- Quieter and longer sleep intervals.
- 4 kg weight gain and increased mobility.
*As of this date, no official diagnosis has been determined for Mr. Hubbi’s condition.

2. Detailed Medical History:
August 20/2007- Severe Sinusitis lasting 2 weeks.
Medications: Klacid 1000, Rociflex 1g injections, Cetacodeine
Notes: Hoarseness began
Loss of some taste ability began
May,June/2009- Start of muscle spasms in left arm, weakness in left hand, weakness in
jaw muscles, mild paresis of mouth muscles (difficult to kiss). Wife noticed emotional
fragility.
August 17/2009- developed hypertension (150/90), indigestion/burping, increased throat-
clearing.
Medication: Zantac, Claritin. Tinormin for BP then later Zestril.
August 24/2009- Neurologist seen.
Medications: Naxiprozol, Orientyl 25, Clona Ril 0.5mg
September 2009- Increase heartburn, regurgitation, increase throat clearing, decreased
concentration ability (spelling mistakes),
- gastroenterologist seen.
- Medications: Losic, Amoxil, Klacid, Fasigyn
- Gastroscopy results: Esophagitis Grade A (according L.A. classification)
End of September 2009- Acute choking event.
October 6/2009- CT Scan of chest, neck and sinuses:
- Chest Scan - Chest appears within normal. Vertebral degeneration.
- Neck- Spiral Scan with contrast shows a deviation of left vocal chord toward
midline without obvious mass.
- Sinuses Scan- Gross enlargement of nasal concha. Obscure left maxillary
sinus.
October 8/2009- Pulmonologist/Internist seen to improve voice.
- Medications prescribed: Unicyclin 100 (Doxycyclin), Diprofos, Pronerve.
- Blood work within normal: Biochem, Immun. Chem, Hematology, Infec
disease, Serology, Microbio (TB)
November 12/2009- Neurologist seen.
- MRI requested: Brain MRI sagital, coronal and axial
T1W-T2W-FLAIR w/o contrast
MRI results: Normal

3. November18/2009- Spinal Tap
- Normal
November 19/2009:
- Ganglioside Antibody test
- Anticoag workup
- MRI of neck w/o contrast
- All Normal
December 2009: Neurologist seen
- Medications: Vitamins, Zoloft, Neurobion.
January 18/2010- Severe Shortness of breath
- Admitted to hospital ICU
January 19/2010: Tracheostomy performed
- Due to high dose of Anesthesia required to sedate patient, required respirator
for 9 hours post surgery.
- Medications: Rociflex shots, Broncholysin, Augmentin, Klacid
** A few days after procedure, wife removes a thick sputum rope/segment through
trach opening, resulting in immediate improvement in voice audibility.**
January 28/2010- Due to persistent cough, a bronchoscopy and bronchial lavage
performed.
-Medications: Fluconazole, Rociflex, Orafar, Nystatin solution, Klacid, Vitamins.