Steve100
02-05-2008, 03:22 PM
Hi
I've included some of the medical reports on my Mother - can anyone tell me if theres anything here that suggests anything OTHER than MND, or if it all fits the Diagnosis? Aplogies for the lengthy post, but there'll be no more like this :)
Steve
June 12 – Gp - On examination I could find no real demonstrable weakness in any of her muscle groups. Her reflexes were extremely brisk and her sensations were normal. Blood tests show ESR of 30 and a slightly raised isolated bilirubin of 32 which is probably not significant.
27th July – Consultant Physician
Symptoms include sensation of muscles tightening up, especially in her neck, feeling tired all the time, poor appetite, weak knees, slurred speech and dysphagia. She is hypothyroid and on replacement therapy for vitamin D deficiency. Systemic enquiry was unremarkable. Speech was slow, Mild dysarthia. Appeared to be fasciculation in her tongue and pwer was reduced in all four limbs,grade 3 mostly. There was small muscle wasting In her hands and deep tendon reflexes were bilaterally brisk. Plantors were extensor bilaterally. There was no clonus or fasciculations. Light touch and pin prick were present throughout , there was some subjective loss of pin prick sensation. There was no sensory level. Co ordination was normal
21st September 2007 – Neuro.
Some pin and needles in her right leg. Normal eye movements and fundoscopy She had rather brisk facial reflexes, She was slightly weak in neck flexion and globally weak in both upper and lower limbs, There was a hint of increased tone although it was not very dramatic in both the upper and lower limbs.
Her reflexes were brisk in the upper limbs, present at the knees and absent at the ankles. Bilateral plantar extensor responses.
In summary she seems to have predominantly motor signs which are a combination of upper and lower motorneuron in nature.
She has had several investigations, including a nerve conduction test, which has shown essentially, normal motor conduction with sensory action potentials of –in the right finger three – of 11.6 and in the right ulnar of 0.5 with an absent right seural.
Emg has shown fibrillation potentials in right tibialis anterior, right quadriceps, right deltoid and right first dorsal interosseous
There were polyphasic units in right tibialis anterior and right quadriceps.
I agree that motor neurone disease does enter the differential diagnosis although the only signs of definite wasting that I saw was in the first dorsal interosseous and one could argue - particularly given the low sensory action potential in the ulnar nerve - that these are the effects of pressure – because she is mainly sitting down now. One could suggest that it is a predominantly upper motorneuron problem that she has, with the only lower motorneuron feature of an unequivocal nature is the wasting in her hands which, as mentioned above, might be due to the effects of pressure on the ulnar nerve,
03/10/07 - Neuro
The lady has had an MRI brain scan which shows several tiny high areas of signal abnormality in the frontal parietal lobes bilaterally but no evidence of mass effect or haemorrhage.
The very small areas of increased signal are non specific. No other significant abnormality is demonstrated.
05/10/07 – Neuro
Diagnosed with MND – MRI of brain and spine which were normal and EMG ‘which was supportive of the condition’. Normal full blood count and normal protein electrophoresis. Her thyroid function and calcium are normal.
Some abnormalities of the liver function test – in terms of a raised ast and raised alkaline phosphatase level - Ck level of 202.
Thyroid function – TSH +6.33
Free T4 -11.7
MR Cervical spine – Slight movement artefact on the sagittal imaging. The spinal cord and central canal appear unremarkable. There is no evidence of cervical myelopathy. Craniocervical junction relationships also normal.
I've included some of the medical reports on my Mother - can anyone tell me if theres anything here that suggests anything OTHER than MND, or if it all fits the Diagnosis? Aplogies for the lengthy post, but there'll be no more like this :)
Steve
June 12 – Gp - On examination I could find no real demonstrable weakness in any of her muscle groups. Her reflexes were extremely brisk and her sensations were normal. Blood tests show ESR of 30 and a slightly raised isolated bilirubin of 32 which is probably not significant.
27th July – Consultant Physician
Symptoms include sensation of muscles tightening up, especially in her neck, feeling tired all the time, poor appetite, weak knees, slurred speech and dysphagia. She is hypothyroid and on replacement therapy for vitamin D deficiency. Systemic enquiry was unremarkable. Speech was slow, Mild dysarthia. Appeared to be fasciculation in her tongue and pwer was reduced in all four limbs,grade 3 mostly. There was small muscle wasting In her hands and deep tendon reflexes were bilaterally brisk. Plantors were extensor bilaterally. There was no clonus or fasciculations. Light touch and pin prick were present throughout , there was some subjective loss of pin prick sensation. There was no sensory level. Co ordination was normal
21st September 2007 – Neuro.
Some pin and needles in her right leg. Normal eye movements and fundoscopy She had rather brisk facial reflexes, She was slightly weak in neck flexion and globally weak in both upper and lower limbs, There was a hint of increased tone although it was not very dramatic in both the upper and lower limbs.
Her reflexes were brisk in the upper limbs, present at the knees and absent at the ankles. Bilateral plantar extensor responses.
In summary she seems to have predominantly motor signs which are a combination of upper and lower motorneuron in nature.
She has had several investigations, including a nerve conduction test, which has shown essentially, normal motor conduction with sensory action potentials of –in the right finger three – of 11.6 and in the right ulnar of 0.5 with an absent right seural.
Emg has shown fibrillation potentials in right tibialis anterior, right quadriceps, right deltoid and right first dorsal interosseous
There were polyphasic units in right tibialis anterior and right quadriceps.
I agree that motor neurone disease does enter the differential diagnosis although the only signs of definite wasting that I saw was in the first dorsal interosseous and one could argue - particularly given the low sensory action potential in the ulnar nerve - that these are the effects of pressure – because she is mainly sitting down now. One could suggest that it is a predominantly upper motorneuron problem that she has, with the only lower motorneuron feature of an unequivocal nature is the wasting in her hands which, as mentioned above, might be due to the effects of pressure on the ulnar nerve,
03/10/07 - Neuro
The lady has had an MRI brain scan which shows several tiny high areas of signal abnormality in the frontal parietal lobes bilaterally but no evidence of mass effect or haemorrhage.
The very small areas of increased signal are non specific. No other significant abnormality is demonstrated.
05/10/07 – Neuro
Diagnosed with MND – MRI of brain and spine which were normal and EMG ‘which was supportive of the condition’. Normal full blood count and normal protein electrophoresis. Her thyroid function and calcium are normal.
Some abnormalities of the liver function test – in terms of a raised ast and raised alkaline phosphatase level - Ck level of 202.
Thyroid function – TSH +6.33
Free T4 -11.7
MR Cervical spine – Slight movement artefact on the sagittal imaging. The spinal cord and central canal appear unremarkable. There is no evidence of cervical myelopathy. Craniocervical junction relationships also normal.
