limegreenphysicist
Distinguished member
- Joined
- Feb 19, 2010
- Messages
- 228
- Country
- US
- State
- Alabama
- City
- Auburn
Hey you guys I know I have had a few inquiries of my diagnosis and my labs and EMG. This is long but maybe it will help some of you differentiate as to why I was not diagnosed with ALS but Mononeuritis Multiplex.
Findings:
Motor Conduction:
Bilateral median motor nerves were within normal limits. However, the distal latency on the right was prolonged in comparison to the left, although this may have been technical as amplitude on the right was actually greater and were were not able o measure skin temperature today. Conduction velocity on the right also was greater and both were within normal limits. Bilateral ulnar motor nerves were evaluated and although within normal limits the latency on the right was prolonged compared to the left and the amplitude on the right with small compared to the left.
In addition, conduction velocity on the right was significantly slower compared the left. The latency on the right was 2.9 ms; on the left was 2.6. Amplitude on the right was 4.1 mv, on the left was 6.9 and conduction velocity was 63.8, on the right, 71.3 on the left.
Bilateral peroneal motor nerves were also within normal limits although latency on the right at 5.8 ms was prolonged compared to the left at 4.5. amplitude on the right at 2.7 mv was small compared to the left at 6.8, and conduction velocity was equivalent bilatyerally at 50ms. Bilateral tibial motor nerves were again within normal limits although amplitued on the right was smaller than the left at 8.1 mv versus 10.1. However, again latencies was actually shorter on the right and this may have been technical.
Sensory Conductions:
Bilateral median sensory nerves were obtained. The left was within normal limits. The right showed a prolonged peak latency at 3.6 ms, upper limit of normal being 3.5. Incontrast, the left peak latency was 2.7. Amplitudes were within normal limits bilaterally.
Bilateral ulnar sensory nerves were within normal oimits although peak latency on the right was slower at 2.8 ms than the left at 2.5, and amplitude on the right was smaller at 12mv versus 30 on the left. Bilateral sural nerves were within normal limits.
Bilateral superficial peroneal sensory nerves were within normal limits although again peak latency on the right at 4.1 ms was prolonged compared to the left 3.3. amplitudes were equivalent bilaterally.
Delayed Responses:
F waves of bilateral median nerve were within normal limits. F waves of bilateral ulnar nerves were within normal limits, although the right was somewhat prolonged compared to the left at 27.9 versus 24.5 ms. F waves of bilateral peroneal nerves were within normal limits as were bilateral tibial nerves.
EMG:
EMG of right upper extremity, right lower extremity, and paraspinal thoracic area were performed. The thoracic paraspinals were entirely within normal limits.
The right upper extremity was significant for occasional fibrillations in the first dorsal interosseous with increased motor unit amplitudes, prolonged duration with polyphasia.
The right lower extremiyt showed abnormalities in both right vastus lateralis and gastrocnemius, again with fibrillations and in the case of the vastus lateralis, occasional giant motor units of greater than 4 mv with increased duration.
Impression:
Findings are consistent with a mononeuritis multiplex with evidence of both the generation and regeneration of EMG. This is consistent with a neuroborreliosis.
Associated Labs:
Abnormalities:
Epstein Barr Early Antigen Antibody
Epstein Barr IGG
Epstein Barr VCA IGG
Lymphocyte Absolute was Low
Increase in Gamma Globulin in CSF
Monocyte in CSF Elevated
Impression: Autoimmune response and evidence of Chronic infection.
Final Diagnosis: Mononeuritis Multiplex secondary to Neuroborreliosis.
So there is the final opinion. I think the clean paraspinals and the NCV findings are what led to my diagnosis.
But finally I have a diagnosis.
I start glutathione pushes and oxygen infusions on thursday. Also I started my yoga today and I ran this morning.
So in this light I am putting ALS out of my mind and concentrating on getting well. These are scary EMG/NCV studies so for all of you paranoid hyperchondriacs...Not everything is ALS and if you have a clean EMG come back on my thread and look at dirty EMG and find comfort in the fact that your "clean" and that you arent me or the other amazing wonderful PALS on this forum.
And to all the worry warts..yes I will always be nervous about ALS but I am choosing to believe my world renowned ALS (20years) specialist from a research medical hospital instead of Dr. Giggles....and get on with my life the best I can and if I develop ALS in the future...so be it, it was meant to be and I cant do anything about it so...I'm choosing to live..and I'm choosing to fight what I have.
Love you guys,
Kelly
Findings:
Motor Conduction:
Bilateral median motor nerves were within normal limits. However, the distal latency on the right was prolonged in comparison to the left, although this may have been technical as amplitude on the right was actually greater and were were not able o measure skin temperature today. Conduction velocity on the right also was greater and both were within normal limits. Bilateral ulnar motor nerves were evaluated and although within normal limits the latency on the right was prolonged compared to the left and the amplitude on the right with small compared to the left.
In addition, conduction velocity on the right was significantly slower compared the left. The latency on the right was 2.9 ms; on the left was 2.6. Amplitude on the right was 4.1 mv, on the left was 6.9 and conduction velocity was 63.8, on the right, 71.3 on the left.
Bilateral peroneal motor nerves were also within normal limits although latency on the right at 5.8 ms was prolonged compared to the left at 4.5. amplitude on the right at 2.7 mv was small compared to the left at 6.8, and conduction velocity was equivalent bilatyerally at 50ms. Bilateral tibial motor nerves were again within normal limits although amplitued on the right was smaller than the left at 8.1 mv versus 10.1. However, again latencies was actually shorter on the right and this may have been technical.
Sensory Conductions:
Bilateral median sensory nerves were obtained. The left was within normal limits. The right showed a prolonged peak latency at 3.6 ms, upper limit of normal being 3.5. Incontrast, the left peak latency was 2.7. Amplitudes were within normal limits bilaterally.
Bilateral ulnar sensory nerves were within normal oimits although peak latency on the right was slower at 2.8 ms than the left at 2.5, and amplitude on the right was smaller at 12mv versus 30 on the left. Bilateral sural nerves were within normal limits.
Bilateral superficial peroneal sensory nerves were within normal limits although again peak latency on the right at 4.1 ms was prolonged compared to the left 3.3. amplitudes were equivalent bilaterally.
Delayed Responses:
F waves of bilateral median nerve were within normal limits. F waves of bilateral ulnar nerves were within normal limits, although the right was somewhat prolonged compared to the left at 27.9 versus 24.5 ms. F waves of bilateral peroneal nerves were within normal limits as were bilateral tibial nerves.
EMG:
EMG of right upper extremity, right lower extremity, and paraspinal thoracic area were performed. The thoracic paraspinals were entirely within normal limits.
The right upper extremity was significant for occasional fibrillations in the first dorsal interosseous with increased motor unit amplitudes, prolonged duration with polyphasia.
The right lower extremiyt showed abnormalities in both right vastus lateralis and gastrocnemius, again with fibrillations and in the case of the vastus lateralis, occasional giant motor units of greater than 4 mv with increased duration.
Impression:
Findings are consistent with a mononeuritis multiplex with evidence of both the generation and regeneration of EMG. This is consistent with a neuroborreliosis.
Associated Labs:
Abnormalities:
Epstein Barr Early Antigen Antibody
Epstein Barr IGG
Epstein Barr VCA IGG
Lymphocyte Absolute was Low
Increase in Gamma Globulin in CSF
Monocyte in CSF Elevated
Impression: Autoimmune response and evidence of Chronic infection.
Final Diagnosis: Mononeuritis Multiplex secondary to Neuroborreliosis.
So there is the final opinion. I think the clean paraspinals and the NCV findings are what led to my diagnosis.
But finally I have a diagnosis.
I start glutathione pushes and oxygen infusions on thursday. Also I started my yoga today and I ran this morning.
So in this light I am putting ALS out of my mind and concentrating on getting well. These are scary EMG/NCV studies so for all of you paranoid hyperchondriacs...Not everything is ALS and if you have a clean EMG come back on my thread and look at dirty EMG and find comfort in the fact that your "clean" and that you arent me or the other amazing wonderful PALS on this forum.
And to all the worry warts..yes I will always be nervous about ALS but I am choosing to believe my world renowned ALS (20years) specialist from a research medical hospital instead of Dr. Giggles....and get on with my life the best I can and if I develop ALS in the future...so be it, it was meant to be and I cant do anything about it so...I'm choosing to live..and I'm choosing to fight what I have.
Love you guys,
Kelly
