Seems worrying

[Srif]

Hello I’m a 37 year old female. A month and a half ago I experienced sudden weakness in my right calf which affected my ability to walk. It then spread to my right hamstring and glute and now my upper arm for the past 2 weeks. I experience stiffness and cramping and have to make an effort to actively engage different muscles to perform regular movements and they and up stiff and cramp. I get random twitches in those muscles. My emg is attached, showing fibrillation and signs of active denervation of muscles in the right leg. It was done on both legs. I also have positive babinski sign in both legs. This all started after exposure to the heavy metal gadolinium from an unrelated mri scan of my heart which was clear it caused me an array of symptoms which I never had and most recently this. Could this be ALS? Ps. The option for attaching the EMG disappeared

 

[Srif]

 

[lgelb]

Myositis (an inflammatory myopathy, affecting the muscles directly, not the nerves that control them) is not nearly the same as ALS and much more treatable.

You should consult with your neurologist for next steps -- they may recommend a muscle biopsy or other testing.

 

[Srif]

My neurologist already ruled out myositis based on blood tests and symtpoms. He says this is not the cause for the abnormal readings of the EMG, that is why i posted for opinions here! I wouldnt worry if i actually had myositos. Based on the EMG readings, and described symtpoms, i am worried. He scheduled me to repeat the EMG elsewhere. If anyone has any insight id appreciate it.

 

[lgelb]

The table is vague, but "increased" recruitment with polyphasic motor units is not ALS but could depending on the rest of the findings be consistent with some myopathies. Myositis signifies an inflammatory myopathy.

 

[Srif]

Ok, and fibrilations also?

 

[lgelb]

The fibrillation potentials signal acute denervation, suggesting an ongoing process, but there's a wide range of processes it can represent, many pretty benign, so that's why I'd expect further testing to narrow it down. Meanwhile, mixing up your position in the way you sleep and sit couldn't hurt.

 

[Srif]

Thank you for replying and for your time. The weakness progressing from right leg to right arm is really concerning to me as well as the EMG. I love in egypt and dont think there are specialized drs here.

 

[Srif]

Follow up emg attached. I have fast progression of weakness in my right arm hand shoulder and leg and here is the evidence again on emg which shows progression. I haven’t been diagnosed yet as unfortunately in Egypt we don’t have als specialists and even the emgs aren’t the most up to date. The diagnostic impression written by the neurophysiologist is not really taken into account as a correct diagnoses because of the lack of experience. Can anyone tell from this emg what is going on? The clinical exam shows weakness and atrophy is visible.

 

[Srif]

Thank you for taking the time. I have repeated the emg below because of progression. If you have a minute to look I’d really appreciate it

 

[lgelb]

The report is very reassuring as regards ALS, and it appears that the examiner is qualified to rule out MND, though the conclusion is stated differently than some. Have you had a virus or questionable illness in the last several months? What does your physician consider next steps?

"Progression" begs the question of "progression of what," and just because the reports are different doesn't mean that something dangerous is happening.

I have seen no documented cases of CNS disorders caused by leftover gad.