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Neurology (Expert Forum)
ALS concern - Expert opinion needed
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ALS concern - Expert opinion needed
by Dman123, Nov 21, 2006 12:00AM
Are the following symptoms indicative of ALS? I am a 35 year old male. These symptoms began suddenly a few weeks ago and have progressed very quickly.
1 Initial symptom was tingling in lower legs. Within a few days, I was getting fasciculations up and down both legs. I also began to experience them on the backs of both upper arms and through my rib/abdomen area. I now predominantly feel them in my calves, thighs, arches of feet, and butt. I feel them less frequently in my triceps, deltoids, back, biceps, chest, and forearms.
2 Shortly thereafter, tingling/tremors in my upper back started. This was followed by soreness and a burning sensation in the tops of both shoulders. This is ongoing
3 I experience a dull ache in my left calf and right forearm. These are intermittent. I have also experienced the same feelings on one occassion in my bilateral upper legs.
4 I am somewhat constipated. I also feel like I have a slight problem breathing when I am sitting down or after eating.
5 I have lost approximately 10-15 lbs that I cannot explain through diet or exercise. I have, however, been able to put a few of the lost pounds back on.
6 I have noticed some tremors in my hands when squeezing things. I also have an occasional involuntary contraction of the fingers, legs, arm, or shoulders while falling asleep. I have not noticed any weakness or asymetrical atrophy.
7 Slightly dry mouth and nasal passages. I think this makes swallowing dry foods somewhat more difficult. I do not have problems swallowing liquids.
Thanks for your help.
1 Initial symptom was tingling in lower legs. Within a few days, I was getting fasciculations up and down both legs. I also began to experience them on the backs of both upper arms and through my rib/abdomen area. I now predominantly feel them in my calves, thighs, arches of feet, and butt. I feel them less frequently in my triceps, deltoids, back, biceps, chest, and forearms.
2 Shortly thereafter, tingling/tremors in my upper back started. This was followed by soreness and a burning sensation in the tops of both shoulders. This is ongoing
3 I experience a dull ache in my left calf and right forearm. These are intermittent. I have also experienced the same feelings on one occassion in my bilateral upper legs.
4 I am somewhat constipated. I also feel like I have a slight problem breathing when I am sitting down or after eating.
5 I have lost approximately 10-15 lbs that I cannot explain through diet or exercise. I have, however, been able to put a few of the lost pounds back on.
6 I have noticed some tremors in my hands when squeezing things. I also have an occasional involuntary contraction of the fingers, legs, arm, or shoulders while falling asleep. I have not noticed any weakness or asymetrical atrophy.
7 Slightly dry mouth and nasal passages. I think this makes swallowing dry foods somewhat more difficult. I do not have problems swallowing liquids.
Thanks for your help.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Dec 10, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms you describe are not likely to be ALS (Amyotrophic Lateral Sclerosis or Motor Neuron Disease). Your symptoms are mostly sensory in nature (tingling/pain), while ALS presents with motor symptoms (weakness, atrophy). Fasiculations can occur in many different circumstances and only concerning in the presence of other concerning symptoms (such as weakness and atrophy). Fasiculations can occur in normal people, with excessive exercise, after some viral infections, with metabolic disturbances, and in some neuromuscular diseases including ALS. Given your symptoms I would recommend an MRI of your brain and spine to rule out a strucural lesion and/or multiple sclerosis etc (unlikely). I would then recommend that you get an EMG (muscle-nerve test) that can evaluate for any of the electrical signs of neuro-muscular disease (including ALS). I would also recommend some routine blood work including electrolytes, TSH, ANA, ESR, Vitamin B12 and B6 levels, and Vitamin E level.
I hope this has been helpful.
The symptoms you describe are not likely to be ALS (Amyotrophic Lateral Sclerosis or Motor Neuron Disease). Your symptoms are mostly sensory in nature (tingling/pain), while ALS presents with motor symptoms (weakness, atrophy). Fasiculations can occur in many different circumstances and only concerning in the presence of other concerning symptoms (such as weakness and atrophy). Fasiculations can occur in normal people, with excessive exercise, after some viral infections, with metabolic disturbances, and in some neuromuscular diseases including ALS. Given your symptoms I would recommend an MRI of your brain and spine to rule out a strucural lesion and/or multiple sclerosis etc (unlikely). I would then recommend that you get an EMG (muscle-nerve test) that can evaluate for any of the electrical signs of neuro-muscular disease (including ALS). I would also recommend some routine blood work including electrolytes, TSH, ANA, ESR, Vitamin B12 and B6 levels, and Vitamin E level.
I hope this has been helpful.
In cases like yours, an initial effort should be devoted to rule out a delayed side effect.
I always suggest an immediate neurologica work-up. Once this has been obtained you may have either a definite picture of your situation or may be at least left with more clarity.
Due to the fact that your symptoms are rapidly escalating I would suggest urgent care.
Rapid syndromes can be very dangerous. Your symptoms are non-specific but could be accounted for by Acute Transverse Myelitis or AED-Lyme disease, depending upon your locale, could produce similar findings.
Amyotrophic Lateral Sclerosis (ALS) is rare, and even more so in your age group.
Good Luck!
Jmcc.
Though Amyotrophic Lateral Sclerosis (ALS) can presnt at your age (I am 28, male), it is highly unlikely. It is most important for you to keep a written/typed journal of what is happening to you. The pathology when it comes to neurology is of extreme importance. For example Multiple Sclerosis and Lupus can present in similar ways but can be differentiated by pathology, and of course, with supporting tests such as MRI.
Do you mind sharing what state you live in? This could help lead us to a better hypotheses. For example, if you are from Northern states such as Washington or New Jersey I would test you for Lyme disease. If your symptoms were restricted to hands and arms I would look at the cervical