Is this ALS

[ALSD]

I met my uncle today who was initially admitted to the hospital for diaphragm collapse on the left side,difficulty breathing and weakness

I did notice there was change in his gait,he was not able to put his right toe properly into the slippers and as he walked,his slippers were coming out.

Also I am not a neurology specialist but a pediatrician with very less experience,I have never seen patients with ALS before,but I do know there should be both UMN and LMN signs

He had the following signs and symptoms :

1.) breathlessness
2.)change in gait
3.) he mentioned fasciculations
4.) he was able to flex/extend his arms against the resistance but he was not able to extend his right leg against the resistance
5.) I felt when I examined him that he had some sensory loss,but can't be sure (my examination was very bried and did not want to freak him out)
6.) His deep tendon reflexes were normal,Except the ankle jerk on the left was decreased.
7.) He did have some difficulty speaking intially,but later he was fine.He talked slowly though( I think because of the breathlessness)
8.)His bowel movements are good,but he did mention about chronic diarrhea for past few months now.He mentioned it was more of mucinous and foamy stuff in the stools
9.)There was no muscle atrophy.
10.) He was eating fine and his mental state exam was okay.

His doctor,whom am yet to meet is currently testing him for everything and ruling out stuff.
His MRI of brain and spine returned normal
He cannot think of any trauma to his back/spine/neck
His Serum studies were normal too.
They have not done a CSF analysis yet and treating with Riluzole w/o confirming the diagnosis.

Please throw some light on what you think is probably wrong and what is the possibility of this disease being ALS?

 

[sadiemae]

If the doctor suspects ALS, he will do an EMG. I would ask the doctor about that. It is impossible to diagnose someone without that test. Sensory issues are not usually associated with ALS

 

[Tokahfang]

Sadie is right, without an EMG it is impossible to tell. I realize it must be very tough, being an md yourself, to be in the position of the worrying and impatient family member. Specialist neuros are great at what they do, and ALS doesn't really benefit from being caught earlier than later (especially if he is already on Riluzole!).

Might I humbly suggest that as a family member instead of the doc in this situation, now would be a good time to spend time with your uncle? The hardest part beyond symptom control is the waiting, the whole world seems to be buzzing around you and it's very lonely. Having someone willing to sit with you, talk with you, and walk with you through the experience means more than any deep tendon reflex test can.

 

[notme]

They are treating with an ALS med with NO EMG? Seriously? Wow, just wow.

The stool issues wouldn't generally be seen in ALS, nor would the sensory issues.

IS an EMG Scheduled? That's the sure way to rule out ALS, I'd think. I"m sorry you're in this situation.

Any new me dic ations that could be causing some of the internal things like stool issues? How old is he?

Normal reflexes is a good sign, but LMN only issues can have many causes. Hopefully, they will find something treatable for him.

 

[glupavomomiche]

I agree... nothing should be done and we can not give an opinion until an EMG/NCV. When that is performed, please let us know the results and we'll do our best to give you our opinions.