Could this be ALS?

[koopatroopa]

Hi:

I am a 28 year old male, non-smoker, occasional drinker.  Excellent health until my symptoms flared up.

I started experiencing tingling and warm sensations throughout both legs about two months ago after performing some heavy leg presses at the gym without warming up (I hadn't worked out my legs in a long time).  These symptoms soon turned to mild pain, greater in the left leg, and exacerbated by exercise.  The leg pain is non specific and mostly dull in nature, punctuated by sharp, non-specific pain that moves throughout the leg (foot, calf, thigh).  More recently, my calves are more affected.  Also, I feel some pain around the knee area, and in the hip joint when I raise my leg by bringing my knee towards me.  My balance is good.  

On June 4, 2007, the right side of my face became numb with mild headaches, so I drove myself to the ER where a brain MRI was performed.  The MRI was negative for signs of stroke, but did reveal a Chiari I malformation with a 5 mm. herniation with no syrinx.  A cervical spine MRI accomplished on June 14, 2007 reconfirmed the Chiari I malformation and showed no syrinxes.  However, the MRI did reveal that there is a C3-C4 3mm left paracentral disc protrusion which causes moderate left anterolateral effacement of the thecal sac, with mild central canal stenosis and mild left neural foraminal narrowing (no right neural foraminal narrowing is seen.  Slight ventral compression of cervical cord).  

Over the course of the last two months, my bilateral leg pain has slowly deteriorated and is my chief complaint, with mild headaches occurring on and off throughout the day.  I had also experienced tingling in both hands, occasional pain in my arms and a feeling of elevated pressure in my head that leads to difficulty focusing when the headaches occur.  These upper body symptoms have mostly resolved, but the leg symptoms remain.  With regards to them, I've now perceived some weakness in my left leg along with the dull pain.  I don't know if it is objective, clinical weakness, as I can still walk, run, and engage in sports.  It is just that I notice that my left leg feels heavier (and in pain).    

I saw a neurosurgeon last week, and he believes that the C3-C4 left spondylosis (which he feels is "recent" on MRI) is causing my headaches and leg symptoms (particulary on the left side), and suggested I use a over-the-door cervical traction unit, which I started using last night.  The doctor did not believe that the Chiari Malformation was causing my symptoms, since my headaches were not exacerbated by exercise or the Valsalva maneuver.  To confirm, he ordered a CINE-MRI flow study across the foramen magnum for CSF flow obstruction, as well as thoracic and lumbar MRI’s for syrinxes.  The CINE-MRI showed no obstruction of CSF flow across the foramen magnum and the spine MRI's turned out negative for syrinx or spine problems.  The neurosurgeon also performed a neurogical exam, which was normal.

I am seeing a neurologist Monday.

Are my symptoms indicative of ALS or something more treatable?  What are your thoughts?  I am concerned.

Thanks.

[sbondnet]

Hi..I had an episode of hematemesis almost 10 months ago...and nohing has been right ever since..i have started loosing muscle mass recently may be 3 months ago...on my knees first and then on my hands...but i have no difficulty  in walking or holding to anything....there are twitche in muscles sometimes, but no stiffness...i have also experienced balance problems like on a boat feeling when I stand in one position..i do also get a superficial headache and pain around my eyes. The dark circles around my eyes have increased and my face looks pale...can anyone suggest me what to do...and do headahe or balance problems occur in ALS??

[doubled1313]

I hope you don't mind me asking, but what wer your brothers early symptoms.  I have read other posting by you that he had bfs and PN for 7 years.  Sorry to ask but I am a little worried.

Thanks a lot

[koopatroopa]

Thanks all for your comments.

Well, neither the cervical traction device nor the physical therapy have helped.  My symptoms have deteriorated: standing becomes increasingly painful and laborious, as both of my legs/knees get very sore with the feeling they're about to give out.  Strangely, leg strength remains good and I can still run 3 miles and make good time.  Most of the pain and leg discomfort arise when I stand, but walking and running dissipate the symptoms, as does sitting and sleeping.

I've also started getting twitches (fasciculations) all over my body, predominantly in my legs...which has me once again concerned.  However, the fact that I am also experiencing sensory symptoms like pain, tingling, heaviness in my legs are somewhat reassuring...given that ALS is purely motor (hopefully!)  

Upper body symptoms have returned over the last few days, with tingly and achy arms, and neck aches.  I am starting to think that my cervical cord compression @ C3-C4 is causing my symptoms, including the fasciculations.

I have a follow-up neuro appt. a week from today, an a couple of neurosurgeon ones after that.  Looks like I won't be able to avoid the EMG this time; besides, I feel like I need it for peace of mind, or some more ominous confirmation.

Two questions:

1. if one has limb-onset ALS in the legs, would standing be painful or rather, would one simply not be able to stand because he/she is weak, with no pain?

2. has anyone experienced my symptoms with cervical cord compression?

This is definitely a humbling experience.

Cheers.

[AintMisbehavin]

glad you avoided EMG. My husband was recently diagnosed with ALS and had EMG last month. Not pretty. I agree with wmac, as well as your second post. There really is no pain, just a gradual paralysis of outer extremeties that moves in towards body over time. Muscles waste away due to the fact that there is interuption in electrical transmission from brain to muscle. Basically, you just cant use it, so you lose it. And worse yet, your body shuts down, but your mind, hearing and such remain sharp as ever. You become trapped within until your lungs just stop. My husband has wasted away dramatically over last few months. He walked at our wedding, in APril and was in wheel chair by May, practically bedridden by June and in Hospital all of July so far. Is progressing unusually fast but, anyway... good luck with your PT and I hope your dr. has the right answer for you.

[koopatroopa]

As an update, I saw the neuro on Monday.  The neuro exam turned out clean, and he felt no need to run EMG's.  He feels that my leg symptoms are due an injury sustained at the gym (perhaps from the leg presses), and wrote me a prescription for physical therapy.  My neuro also mentioned that ALS is painless, and that the neuro exam is typically abnormal with ALS.  To be honest, I am a bit skeptical about physical therapy....let's hope that helps.  

He also ordered ANA, Full Metabolic Panel, and Fasting Diabetes blood tests.  No word on the results, yet.  

Thanks for reading.
  

[wmac]

My neuro told me that if it hurts then its not als.

[alsadvocate]

My brother has ALS, this does no sound consistant with the symptoms.
get your Doc. to check you for Peripheral Neuropathy. Have them do EMG and NVC. Just a suggestion, I have PN.