3 month speech loss, progress to swallowing inability

[TSand]

Question about father-in-law
white male, 70 years old, emphysema, diabetes, lifetime smoker, heart bypass 8 years ago, overweight, TIA 10-12 years ago,as you can see many health issues. Now the most recent:

Sept. 05 diagnosed with light stroke,  speech problem was only sign,  slurred.  speech therapy ensued for app. a month but deterioration continued but was still able to talk.  Over the three month period loss of function continued to progress.  Now he has no speech function and is unable to make sound even when coughing.  Swallowing problems developed over last month, liquid thickening now progressed to consistency of milkshake to keep from choking. Swallowing issue led to pneumonnia and is currently in local hospital, has been for 12 days.

Doctors have done cat scan, pet scan?, mri, etc. and are unable to find any cause, said cancer causing speech and swallowing problem but were unable to find cancer on scans.  Neuro mentioned myasthenia gravis last week but has backed off.  Was prepared to treat even after negative test but changed course. When "alert" has droopy eyelids.  Able to get out of bed with assistance and sit up in chair for extended periods.  No pain in throat area or anywhere else

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

Although I cannot give a clinical diagnosis over the internet, the story you tell does not suggest a structural lesion like a stroke but a more widespread dysfunction of the neuromuscular junction or muscle - things like myesthenia, motor neuron disease, polymyositis, paraneoplasia.

When you say he cannot speak, I presume its that he cannot make the sound to speak, rather loss of language skills (ie also comprehension, reading etc). If there was a generalized loss of language skills also, the diagnosis may be different, and more of a degenerative/dementing type illness rather than a muscular problem.

I'm not sure what you mean by negative test ?tensilon test - this test is only useful if positive, and a negative test does not ruleout myesthenia. Other testing such as blood antibodies (binding, blocking, and modulating acetylcholine receptor antibodies or anti-MUSK antibodies), repetitive nerve stimulation, and single fiber EMG can confirm or refute the diagnosis. An EMG of the bulbar muscles (ie tongue) may be able to investiage motor neuron disease as a cause. Blood levels of CK, and possibly a muscle biopsy (after an EMG with supportive evidence) for a myopathy may be useful , depending on your doctors reccomendations.

Good luck

[TSand]

Thanks for your response. My father-in-law was diagnosed on 12/21 with ALS.  He passed away on 12/23.  His last week was mostly a period of severe breathing trouble.  We wish that he would have been diagnosed sooner but was showing no signs other than the speech issue which his neurologist thought was related to a stroke.  I guess my point is that if the ALS diagnosis had been sooner the family could have been better prepared. Perhaps in future cases this test could be completed sooner!

[TSand]

Diagnosed with ALS this afternoon.  Thanks for the opportunity to at least ask.