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Neurology (Expert Forum)
ALS, been scared to death for 4 months now
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ALS, been scared to death for 4 months now
by Luke 339, Apr 19, 2006 12:00AM
I am 31 year old Male with some symptoms that have been ignored so far by Keiser Permenente. Symptoms started with vertigo, swullen feeling with left eye and ear, fatigue, nausea, lack of appetite, heart beat slowed and beat very hard, night sweats, super stiff neck which i could not move, buring in my left arm and shoulder. The worst was a burning attack that went across the elft side of my head down my left neck which lasted for about 2 1/2 hours in the middle of the night.
Was started on Doxycycline due to the location of where i have lived most of my life East Lyme, CT, they thought maybe lyme. Took abx and some symptoms went away right away such as stiff neck and burning feeling my my left arm and shoulder. Now I have new symptoms which scream ALS. Left Sternomastoid muscle has become smaller then the right (attachment to collar bone has become much thinner and smaller), possible wasting, left neck weakness, left shoulder weakness and loosness, left jaw weakness, left side swallowing difficulty hyoid clicks now(although swallow study showed normal) twitches all over my body (everywhere) started shortly after starting Doxy.
Had Two MRI's done (with contrast) one done at Columbian Pres in NYC, CT scan, EMG, NVS, 4 neuro clinical exams, CK levels checked, ANA, T3, T4, TSH, MG Panel, all normal. Only test so far came back with anythign was testosterone was low.
1)Whats the likelihood of ALS?
2)EMG was done by Chief of Neuro at Keiser on Feb 1st, should i get another one, neuro says no?
3)What else could this be?
4)Is weakness always a first sign of ALS or wasting?
Was started on Doxycycline due to the location of where i have lived most of my life East Lyme, CT, they thought maybe lyme. Took abx and some symptoms went away right away such as stiff neck and burning feeling my my left arm and shoulder. Now I have new symptoms which scream ALS. Left Sternomastoid muscle has become smaller then the right (attachment to collar bone has become much thinner and smaller), possible wasting, left neck weakness, left shoulder weakness and loosness, left jaw weakness, left side swallowing difficulty hyoid clicks now(although swallow study showed normal) twitches all over my body (everywhere) started shortly after starting Doxy.
Had Two MRI's done (with contrast) one done at Columbian Pres in NYC, CT scan, EMG, NVS, 4 neuro clinical exams, CK levels checked, ANA, T3, T4, TSH, MG Panel, all normal. Only test so far came back with anythign was testosterone was low.
1)Whats the likelihood of ALS?
2)EMG was done by Chief of Neuro at Keiser on Feb 1st, should i get another one, neuro says no?
3)What else could this be?
4)Is weakness always a first sign of ALS or wasting?
Doctor's Answer
by CCF-Neuro-M.D.-PW, Apr 25, 2006 12:00AM
1) very low
isolated sternomastoid wasting would be very uncommon, the most common cause of an asyymetry would be increase in size of the opposite size such as in cervical dystonia. Fascicaulations that are more widespread in onset are more likely to be not ALS. They can also be caused by an overactive throid gland, exrecise, cold, certain meds, and as a benign syndrome with or without cramps. To diagnose ALS, objective signs of muscle or spinal cord dysfunction must be domenstrated by the neurological examination or EMG in 3 limbs. ALS does not cause sensory symptoms. The neck stiffness and left sided pain perhaps sounds like a meningoradiculitis that usually are infectious in nature ie Lyme.
2) Depending on the quality of the EMG and how many limbs/muscles were sampled. If EMG of the affected area is normal it is unlikely that an asymptomatic area will be abnormal if tested.
3) I cannot give you a clinical diagnosis over the internet, as this site is purely eductional, but as I mentioned there are other causes of twitching, and other symptoms that are not suggestive of ALS. A spinal fluid analysis would have been helpful perhaps to look for infection or inflammation but may not be helpful at this point, check with your doctors.
4) both come together, but weakness may be more sensitive to clinical testing than visually detecting a change in the appearance of the muscle. THe muscle can lose up to 80% of its 'motor units' before clinical weakness is apparent, on the other hand.
isolated sternomastoid wasting would be very uncommon, the most common cause of an asyymetry would be increase in size of the opposite size such as in cervical dystonia. Fascicaulations that are more widespread in onset are more likely to be not ALS. They can also be caused by an overactive throid gland, exrecise, cold, certain meds, and as a benign syndrome with or without cramps. To diagnose ALS, objective signs of muscle or spinal cord dysfunction must be domenstrated by the neurological examination or EMG in 3 limbs. ALS does not cause sensory symptoms. The neck stiffness and left sided pain perhaps sounds like a meningoradiculitis that usually are infectious in nature ie Lyme.
2) Depending on the quality of the EMG and how many limbs/muscles were sampled. If EMG of the affected area is normal it is unlikely that an asymptomatic area will be abnormal if tested.
3) I cannot give you a clinical diagnosis over the internet, as this site is purely eductional, but as I mentioned there are other causes of twitching, and other symptoms that are not suggestive of ALS. A spinal fluid analysis would have been helpful perhaps to look for infection or inflammation but may not be helpful at this point, check with your doctors.
4) both come together, but weakness may be more sensitive to clinical testing than visually detecting a change in the appearance of the muscle. THe muscle can lose up to 80% of its 'motor units' before clinical weakness is apparent, on the other hand.
If you are suffering these weird symptoms, I suggest you check out the following sites:
www.medicationsense.com
www.fqvictims.org
http://health.groups.yahoo.com/group/quinolones
This swallowing thing is the worst right now, plus my tongue gets pretty tired. Could this be a brainstem lesion causing this?
How do you test for brainstem lesions?
What would muscle biopsy do to rule in or out ALS?
What else could cause swallowing problems on the left side?
Any ideas would be very helpful, thanks.
Thanks