POST VIRAL MYELITIS

[helpke]

Doctor,

Thank you for answering my previous question. Just a couple of other things to help put my mind at rest. As I had mentioned this new weakness in my hands and arms (feeling like I want to drop things) has worsened over the past day or two since it started. This morning I could harldy lift the hair dryer above my head. My fears are still about als. First question: would als present with bilateral weakness like this? Second: Is an emg able to accurately rule out als (esp. bulbar) at two to two and a half weeks into my symptoms as my symptoms have worsened since then? I did however have body fasiculations, generalized weakness and slurred speech as symptoms then (although I dont know if they hypoglossal nerve/tongue was paralyzed then, but probably since my speech was slurred) and I am very comfortable that the doctor that did the exam was competent. Also, I seem to be losing weight/muscle mass. Is this normal for post viral? Thanks for your time and knowledge.

[concernedcass]

Hello,

I just posted a long post, per your original post earlier this week.  I actually am a bit confused with the doctor's response above.  I'm having many similar issues and have seen several doctor's including two different neuro's.  All doctors, particularly a neuro that has been working in this field for 50+ years, said that the presentation (acute onset) is nothing like ALS, particularly b/c you are experiencing in multiple limbs and bulbar at the same time.  He said that ALS DOES NOT present that way or at least not what he has seen in the past 50 years.  According the neuro's I've seen, unless the symptoms have just gone undetected for a period of time and they progress (from bulbar to limbs or vice versa) you do not all of a sudden present with extreme bulbar and multi-limb symptoms.  Post-viral is REAL and can cause all of these symptoms and more with an acute onset impacting multiple body systems.  Are you having any other symptoms?  My understanding of post-viral is that it can take months or even years to recover.  In addition, symptoms can worsen before they get better.  Remember, your body is still under some form of attack right now, your immune system is comprised, and your body is possibly being subjected to latent viruses.  I'd suggest going to post-viral or ME forums...I think you will find A LOT of people with your same symptoms and the same ETIOLOGY.  Remember, you can't just look at the symptoms, but need to look at the etiology as a key to this.  From what I've read about and heard from my neuro's about post-viral and ALS, acute onset at multiple body parts is much more indicative of post-viral.  I hope you get better soon. I, too, am very concerned about ALS.

[Abhijeet Ghosh]

Dear Buddy,
Now i am getting little worried as you said that the weakness in the arms are worsening.ALS can be a possibility but can't say for sure.
About the second question- EMG is not enough to rule out ALS..
I agree that you are comfortable with the present doctor, but it's really advisable for you to go for a second opinion as it's a complex situation we are into.
EMG, EEG, Nerve Biopsy, MRI/CAT scan are few examination name, however, they have to be perfectly co-related with the Signs, which the treating doctor can only elicit.It will include the individual muscle power grading,reflex grading,sensation mapping, etc.
These all came into my mind as the weakness is progressing, which is not a good sign.
So please go for a second opinion.
Regards.