MRI Results-what do they mean?

[aceanddeuce]

Hi- Any help would be great because my husband will not be able to hear the results until Sept. 28th.
My husband is 45, in great shape. Lifts weights, rides dirt bikes, water skies, extremely active, etc. The past few months we noticed faciculations across his chest, arms, and legs. He noticed slight fatigue, some muscle weakness,  but jut got over OT from his job (welder for over 20 years.) We brought him to the doctor because of these signs. His CPK blood work showed 100 over the normal range, so his PC recommended a Neurologist. They did an EMG which showed normal nerve, but abnormal muscle. We were told the numbers were bad. MRI's were on order and received the results yesterday. These are from the Spine Cervical and the brain w/wo contrast. Spine Cervical:
Impression: Degenerative changes and bulging throughout the cervical spine. Cannot rule out mild nerve root entrapment at c6-c7 bilaterally.
Brain:
the ventricles of normal size and shape. There is no shift of the midline noted. There are no extra-axial fluid collections or areas consistent hemorrhage noted. No masses are seen. No acute infarcts are noted. There is a single focal area of increased signal in the periventricular white matter on the left on image #20 of the Flair seq. Differential for this would include ischemia and demyelinating disease. The pituitary appears normal. There are normal flow voids seen at the carotid siphons. No enhancing lesions are noted.
Impression: Single small focal air of increased signal in the periventricular white matter on the left otherwise, negative.
They are suggesting  this is ALS.  However, no slurring of speech, tripping, trouble opening doors, etc.  No noticable muscle loss. Does this spot on the MRI rule out ALS?  Could the EMG be abnormal because the spine has the degenerative changes throughout.  We are just stunned with this news and hope anyone can shed some light.  Thanks for your time.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

It must be emphasized that in the MAJORITY of cases muscle twitches are benign meaning that they are of no consequence and are not resulting from a serious cause. In such cases, the twitches may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake. Tremors of the hands can be physiological that is exacerbated by stress/anxiety and caffeine.

Benign fasciculation syndrome, i.e., BFS, is a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low.

When BFS is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

However in general (and please understand I am not trying to imply I feel this is the case in you), when fasciculations occur in the setting of associated symptoms such as progressive loss of sensation, tingling or numbness, weakness, trouble swallowing and other symptoms, the cause may be due to a peripheral nervous system problem. In general the symptoms would not be episodic and triggered by certain things but would be more constant/frequent without consistent triggers. The location of the problem could be the anterior horn cells, the area where the nerves that supply motor innervation to our body comes from. These are the cells that give off the nerves that allow us to voluntarily contract our muscles. The diseases that might affect the anterior horn cells include ALS (also called Lou Gherig's disease), a condition called spinal muscular atrophy, polio-like viruses, west nile virus, and other infections.

Another nervous system problem, peripheral neuropathy, may also lead to fasciculations. There will again be associated weakness or sensory changes.

The MRI does not rule out or in ALS. It is difficult to say what the EMG findings mean, but degenerative disease of the back can cause a neuropathy which can lead to EMG abnormalities.

I agree that you should follow up with the neurologist for a complete neurological evaluation including reviewing your records more thoroughly.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[aceanddeuce]

Thanks for your reply.  Your information was very helpful. A few quick questions-

Would BFS cause an abnormal EMG?

Would degenerative disease of the back cause fasciculations and muscle weakness?

Could an EMG performed by one specialist have a different outcome performed by another?

Should we ask for a spinal tap and muscle biopsy before seeing the doctor to have more information to look at it?  Again, thanks for your response.