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      Re: ALS?

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Posted by CCF neuro MD on January 14, 1998 at 11:30:14:

In Reply to: ALS? posted by Allen on January 13, 1998 at 19:08:27:

: For over a year I have had large numbers of fasciculations and muscle tension.  In addition, weakness around one side of my mouth that began (or was noticed) suddenly, around Thanksgiving, 1996.  Pain in my neck and shoulders continues into my arm and hand, especially forearm.  In addition, there appears to be wasting in the left hand and on objective measures, my left hand is much weaker than the right.  About seven months ago (which is seven months since my first symptoms) I had a normal EMG at a university clinic.  Also a normal MRI.  I have a long history of fasciculations, but these are much worse.  The pain and weakness in the arm has gone on for six months now.  I was diagnosed with a mild lacunar stroke in the internal capsule and benign fasciculations.  Do I need more tests?  Other ideas?
Your symptoms are not entirely typical for ALs, however it would be
difficult to exclude it entirely on the basis of the testing so far.
Fasiculations are seen in ALS but are also seen in normal people who
get them particularly after exercise.
The pain in your arm in association with the weakness would also tend to
push the possibilities away from ALS.
The lacunar stroke could cause arm weakness and rthe combination of
lacunar stroke with benign fasiculations sounds feasible.
I would be further reassured by the normal EMG.
Your symptoms could be partly related to nerve entrapment
in the neck but this should be obvious on an MRI of your cervical spine,
If your symptoms continue to progress I would consider repeating the EMG
of your left arm, with sampling of other muscles to see if this is a more generalised process.
As regards imaging an MRI of your cervical spine should be done, I presume the lacunar stroke was
seen on a brain MRI, so a cervical MRI is also required if not done already.

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