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Neurology (Expert Forum)
Lots of symptoms - no clear answers... please help!
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Lots of symptoms - no clear answers... please help!
by stephz, Dec 19, 2005 12:00AM
Fasciculations all over, mostly in triceps, calves, thighs. More on R side. Can create at will w/ contractions. Started 8 wks ago. No weakness, no tripping, slurring, or coordination problems.
37 yr male, overall good health. No focal muscle mass loss, 5/5 strength in all areas Normal gait, slight assym of reflex w/ upper extremeties less than lower, normal response to pinprick and vibration. R lower numbness and tingling from Sciatica.
EMG:
Motor NCS R peroneal nerve over EDB normal.
RNS of R ulnar normal. Sensory NCS of right ulnar and sural sensory normal. Needle demonstrates fib potentials in R tibialis ant, R pronator teres, biceps, & triceps. Scattered fasc potentials seen. Neurogenic MUPs seen in the R L5-S1 myotomes & scattered throughout the R upper extremity, max in the R C6-7 myotome. Some scattered signs of chronic active denervation in the R C6-7 and L5 myotomes. May reflect an early MND; but given the relative focality of the abnormalities & some radicular complaints, need to exclude focal radiculopathies in these areas.
Columns across the top: Spontaneous: IA, Fib, Fasc, H.F., MUAP: Amp, Dur, PPP, Recruitment: Pattern. Everything a "N" except:
R. Tib Anterior = Increased IA, 2+ Fib, 1+ Fasc
R. Gastrocn (Med) = +1 Fasc, 1+ Amp, 1+ Dur
R. T Fascia Lata = 1+ Amp, 1+ Dur
R. First D Inteross = 1+ Red Recruitment Pattern
R. Pron Teres = Increased IA, 2+ Fib, 1+ PPP, 1+ Red Recruitment
R. Biceps = Increased IA, 1+ Fib, 1+ Red Recruitment
R. Triceps = Increased IA, 1+ Fib, 1+ Facs, 1+ Amp, 1+ PPP, 2+ Red Recruitment
R. Deltoid = 1+ PPP
Thanks!
37 yr male, overall good health. No focal muscle mass loss, 5/5 strength in all areas Normal gait, slight assym of reflex w/ upper extremeties less than lower, normal response to pinprick and vibration. R lower numbness and tingling from Sciatica.
EMG:
Motor NCS R peroneal nerve over EDB normal.
RNS of R ulnar normal. Sensory NCS of right ulnar and sural sensory normal. Needle demonstrates fib potentials in R tibialis ant, R pronator teres, biceps, & triceps. Scattered fasc potentials seen. Neurogenic MUPs seen in the R L5-S1 myotomes & scattered throughout the R upper extremity, max in the R C6-7 myotome. Some scattered signs of chronic active denervation in the R C6-7 and L5 myotomes. May reflect an early MND; but given the relative focality of the abnormalities & some radicular complaints, need to exclude focal radiculopathies in these areas.
Columns across the top: Spontaneous: IA, Fib, Fasc, H.F., MUAP: Amp, Dur, PPP, Recruitment: Pattern. Everything a "N" except:
R. Tib Anterior = Increased IA, 2+ Fib, 1+ Fasc
R. Gastrocn (Med) = +1 Fasc, 1+ Amp, 1+ Dur
R. T Fascia Lata = 1+ Amp, 1+ Dur
R. First D Inteross = 1+ Red Recruitment Pattern
R. Pron Teres = Increased IA, 2+ Fib, 1+ PPP, 1+ Red Recruitment
R. Biceps = Increased IA, 1+ Fib, 1+ Red Recruitment
R. Triceps = Increased IA, 1+ Fib, 1+ Facs, 1+ Amp, 1+ PPP, 2+ Red Recruitment
R. Deltoid = 1+ PPP
Thanks!
Doctor's Answer
Bloodwork:
Everything is within normal ranges except:
Glucose = 114 (high - diabetic neuropathy?)
ALT = 46 (high - viral infection?)
MPV = 6 (low)
Lymph = 17 (low - )
Seg = 75 (high - )
Ca Channel Bind Ab, P/Q = 0
Ca Channel Bind Ab, N = TNP
ACh Resep Muscle Bind Ab = 0
Lyme Antibody Screen = Negative
ANA Screen = Negative
Paraneoplast CRMP5 IgG = Negative
TSH Hormone = 1.7 (normal)
PTH Hormone = 45.4 (normal)
Miscellaneous:
I don't have the facts, but he says that the following have been ruled out: Huntington's Disease, Kennedy's Disease, Lyme Disease, HIV
He has pain in lower back and in neck. When he sits with his legs crossed, they go numb.
When he pulls his chin to his chest and arches his back, the fasciculations in his arms go away.
Questions:
1. Could he have MMN or D-LMN instead? He doesn't appear to have any muscle weakness and his physical exam showed no upper motor neuron loss at this time.
2. How come he was told there is a strong possibility of ALS when everything I've read says it's not possible without upper motor neuron loss?
3. He was told by his doctor that there's a very small chance it could be a viral infection. How would we know?
4. His mild stenosis, bulging, and sciatica were promptly dismissed as being part of the problem.
Why - especially when EMG shows concern in the same areas where stenosis or bulging occurs?
5. Could this be a combination of other things and not necessarily ALS?
Thank you so much!
Thank you SO much for taking the time to share information!
I will look at those sites and share this with my brother.
At this point in time, all we want are answers so that we can move in the correct direction towards recovery, if possible.
God bless
Furthermore, Carol isn't expressing negativity toward our doctors, she is merely pointing out her belief that a particular test method might not be as reliable as others.
If another lady comes on here and says that Carol might have played a role in saving the life of her little child, that sounds pretty wonderful to me.
Worse case scenario- you get a negative Lyme test.
Carol, if I might ask your opinion, what is the most reliable test method for Lyme's, based on your research, experience, etc? Is it the PCR, a different one?
Thanks for the help, if you find the time to respond. We will be moving soon, so I had to request that my account be closed down for now-but if you do respond, I'll try to sneak online at some point in the coming days to see if you reply. Thanks a bunch.
I have had these symptons for around 3 years now. A dull aching pain down my right arm and up the right side of my neck. Sometimes my arm goes numb and it feels very weak. I have been to my doctor may times and they dont know what it is. I have been for a general radiology scan on my shoulder and arm and it came back fine. I need some help as I dont know which way to turn. I am 21 and dont want this pain anymore!!
Please help I would apprecaite any comments you may have
Thanks
Loz