ALS concern - Expert opinion needed

[Dman123]

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.

[CCF-Neuro-M.D.-SH]

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.

[mike1105]

i think it's be a good idea to visit your MD for a full physical/bloodwork/possible referral to a neurologist. you may want to visit the cleveland or mayo clinic to expediate the process. without testing, it could be a myriad of things.

[johnflox]

Did you take strong medicines some weeks prior to the onset of your symptoms? The description of your symptoms fits with many disorders. One of them is a delayed reaction to certain drugs. All your symptoms are identical to the adverse effects of some neurotoxic drugs like cipro, levaquin, avelox, inmunosuppressors, and antimalarials.

In cases like yours, an initial effort should be devoted to rule out a delayed side effect.

[Dman123]

I haven't been on any medication.  Under a lot of stress though.  I was previously informed that I have "Impaired Glucose Tolerance (IGT)."  Does this have any bearing?

[JCmcc]

DMan,

   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.

[JCommish]

Hello, I am a 29 year old male.  11 days ago I started getting a strange sensation in my feet while sitting at my desk for a prolonged period of time.  It was almost like a numb, tingly feeling.  I went to the gym later that day and ran 5 miles.  Really werent any immediate ill effects after that, but when I went to sleep that night, I noticed my feet were very hot, like a burning sensation.  By the next day it was even worse and I got so freaked out I actually went to the emergency room.  Naturally they really couldnt do anything for me there and so I scheduled to see my family physician on Wednesday.  We scheduled an ABI and circulation test, which was preformed last Friday and an EMG, which was preformed this past Tuesday.  I have yet to get the results.  During this time, my hands and arms have started to get into the act.  I wake up with my arm and hand asleep, depending on which side I'm sleeping. After I wake up and notice this, I began to feel twicthes and slight muscle spasms.  They are much more prevalent when I am most relaxed and about to go to sleep.  They make me jump and I havent been sleeping much at all the past 10 days.  I guess I should mention my feet feel a bit better but my arms and hands have been worse.  Also, whenever I am sitting or lay on one side for a long period of time, the area gets very hot, like the blood just sits there and boils.  I should also mention, although it probably has nothing to do with my hand and feet issues, that during this time I have been diagnosed with a stomach bacterial infection(H. Pylori) and had an endoscopy yesterday which found a couple of ulcers.  It has been causing my acid reflux and my tight feeling in my throat due to the acid affecting my esophagus. Not a major issue as relayed by the gasteroentoroligist.  Anyway, I'd appreciate any feedback.  I understand that stress and anxiety could exacerbate, and it probably is doing so, but it can be scary.

[JCmcc]

JC,

  

Though