fasiculations

[Elaine]

My huband has been experiencing fasiculations that started in primarily in his left shoulder and now are more generalized.  He complains of weakness, fatigue, and lack of energy, weakness especially in the shoulder area. He does not have any pain.  However he does have some low back pain.  On exam, the doctor said that he is noticeably weaker on the left and muscles are less defined.  The EMG showed cervical radiculopathy at C5 and C6.  MRI of cervical spine was indicative of spondylosis.  Our concern is that this may be something more than degeneration.  He has an appointment with neuro June 26.  Are these symptoms consistent with spondylosis or more with ALS.  I think he appears generally depressed as well.  Any information you can give me will be of great assistance.  Thanks.

[CCF Neuro[P] MD, RPS]

Dear Elaine:

A cervical radiculopathy at C5 and C6 and a cervical spondylosis certainly could give fasciculations in the shoulder.  Usually, there is also a pain or numbness component to a radiculopathy. However, without pain or numbness does not preclude this diagnosis.  I am assuming that the EMG did not find any other abnormalities with the exception of C5 and C6.  I am not sure what to make of the lower back pain as this doesn't fit (nor would it fit a diagnosis of ALS).  Based on what you have told me, I would say that the fasciculations are due to the radiculopathy and/or spondylosis.  The criterial for ALS by EMG include 3 different muscle groups with fibrillation, fasciculations, or sharp waves all of which your husband does not have.  

Sincerely,

CCF Neuro MD

[Brain Lesions and low WBC]

Can't seem to find the right time to be allowed to post correctly. Sorry!!
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Can these problems be related and not two separate problems? The Dr.s here treat them as two and hasn’t looked at the possibility of one. If so is there a specialist who would look at it in that light? I live in NH so going to Boston isn't out of the question.
In Jan. of this year I had what the Dr. said was the flu. Swollen lymph nodes(I had one on the left side of my neck that you could cup your hand around),neck and shoulder pain from them, bad headache, facial pain,(like sinus)earaches, mastoids(behind ears and base of head) fever, severe fatigue; all the classic symptoms of the flu. These problems lasted for several months. I saw an Oral Surgeon because the left side of my face was swollen primarily inside my mouth where wisdom teeth had been removed 4 years earlier. Then I saw an ENT who said my problems were from TMJ, (because he said my ears were fine even though they were hurting constantly) my Dr. and I both dismissed this idea. In March the PA said my headaches were due to allergies and was going to prescribe an allergy med. then changed his mind and decided to do some blood tests. He checked for Mono (which was neg.) and did a CBC, my WBC was 2.2 and my neutrophils were very low. I was told that the headache problem would have to wait until the blood problem was diagnosed.
I was tested for HIV, EBV, CMV, Mono, TB, Thyroid, and organ functions and given a mammogram. NOTHING!! I was then referred to a hematologist and given a prescription for an allergy med. The hematologist did more testing and a bone marrow biopsy. STILL NOTHING!! He said I have a virus that would have to work itself out. WBC maintaining around 2.6 and neuts 800, with swollen lymph nodes throughout my body.
I saw my GP after trying 2 diff. allergy meds. with no results I insisted on seeing an allergist. The allergist found no allergies what so ever. I was then referred to an eye Dr. and a neurologist. The eye Dr. found nothing.
I saw the neurologist on June 20th and his opinion was that I had and possibly still have, in a limited way, viral meningitis. Since my headaches were slightly improved and OOPS I am now 3 1\2 months pregnant we agreed to wait and see what happened. It didn't take long before I had to call him because things had gotten much worse. I had an MRI on June 29th and the radiologist report showed lesions. I spoke with the neurologist and he said he hadn't seen the scans and not to worry it didn't appear to be tumors, he was leaving on vacation the next day and so was I. So we agreed to wait until we both returned and go over the scans and to schedule a lumbar puncture, which I will have on July 14th. My face is a constant dull ache but sometimes (2-3 times a week) I have a killer. I have had several HA's that if I laid down it felt like my head would explode. I have to try and sleep propped in the corner of my couch. If my head/face is hurting now, I know better than to even attempt to lie down. I don't think they are like migraines, no aura or the other things that seem to be related to migraines. The head, face, ear, mastoid, neck and shoulder pain and the low WBC/neutrophils are the only remaining problems that I can think of right now.
Sorry if this post is too long, I felt you should have as much info as possible.

[Bobbi D]

Have you been tested for lyme disease?  You said you live in NH, but could you have visited CT or NY in the recent past and got bitten by a tick?  These symptoms sound pretty typical of lyme.

[Theressa]

No, I haven't been tested but since I didn't have the bullseye rash and couldn't remember being bitten by one the neurologist dismissed the idea. I haven't been to CT or NY within the last couple of years.