Old 03-15-2014, 10:27 AM #31 (permalink)
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Default Re: Question about diagnosis?

I said the doctor said his right side was slightly weaker than his left. He is a lefty. He still passed with a 5/5 on everything. The doctor mentions nothing of clinical weakness in any of the report and he passed a bibinski and hoffsman test.
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Old 03-15-2014, 10:37 AM #32 (permalink)
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Default Re: Question about diagnosis?

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I would also like to say to the anxious people who will use this as a case of he only had twitching and now he has ALS that although Eric's dad only NOTICED twitching he had an abnormal clinical exam with CLINICAL weakness ( read the whole thread and see where Eric mentions this in spite of the 5/5 on the report) and Upper motor neuron signs.
Sorry to interject this here Eric but felt needed to be said. Thank you
I'm also not sure how much reading you ACTUALLY did in this thread, because we don't have a diagnosis yet. We are still in the very early stages.
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Old 03-15-2014, 10:38 AM #33 (permalink)
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Default Re: Question about diagnosis?

Yes I know and you will obviously have to clarify that when you see neuro 1 again. I hope and pray this turns out to be something else for your dad. A negative hoffman and babinski is great but there was mention of other umn signs reflexes I believe. There are a host of people who read here and many have a pathological fear of ALS and decide that if they twitch it must be ALS and will say they read of people who only. twitched and have ALS. Your dad's case is different as he had some findings on clinical exam. That was my point made for them and not at all intended to exaggerate your dad's symptoms.

Yes I read your thread I posted about a second opinion. Again the comments were addressed to the worried twitchers. THEY will take this as a hard and fast diagnosis and run with it. When I said now he has ALS that was a projection of what THEY would say not the current truth I am sorry it was unclear
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Old 03-15-2014, 10:53 AM #34 (permalink)
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Default Re: Question about diagnosis?

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Yes I know and you will obviously have to clarify that when you see neuro 1 again. I hope and pray this turns out to be something else for your dad. A negative hoffman and babinski is great but there was mention of other umn signs reflexes I believe. There are a host of people who read here and many have a pathological fear of ALS and decide that if they twitch it must be ALS and will say they read of people who only. twitched and have ALS. Your dad's case is different as he had some findings on clinical exam. That was my point made for them and not at all intended to exaggerate your dad's symptoms.

Yes I read your thread I posted about a second opinion. Again the comments were addressed to the worried twitchers. THEY will take this as a hard and fast diagnosis and run with it. When I said now he has ALS that was a projection of what THEY would say not the current truth I am sorry it was unclear
It's ok I just wanted to clarify we are no where near a diagnosis yet. Where does it talk about his reflexes? I haven't seen anyone mention that yet.
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Old 03-15-2014, 10:59 AM #35 (permalink)
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Default Re: Question about diagnosis?

Post 16. Your report says hyperreflexia and increased muscle tone. Hyperreflexia as you probably know means increased reflexes which are an upper motor neuron sign. They are of course dependent on the examiner. If you have your dad's neuro exam there will be mention of reflexes as 1plus,2 plus, 3 plus 4 plus. If he is hyperreflexic they should be at least 3 probably 4
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Old 03-15-2014, 11:05 AM #36 (permalink)
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Default Re: Question about diagnosis?

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Post 16. Your report says hyperreflexia and increased muscle tone. Hyperreflexia as you probably know means increased reflexes which are an upper motor neuron sign. They are of course dependent on the examiner. If you have your dad's neuro exam there will be mention of reflexes as 1plus,2 plus, 3 plus 4 plus. If he is hyperreflexic they should be at least 3 probably 4
How does that equate to clinical weakness?
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Old 03-15-2014, 11:08 AM #37 (permalink)
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Default Re: Question about diagnosis?

2 different things altogether though both are found in ALS and, of course, other medical conditions
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Old 03-15-2014, 11:30 AM #38 (permalink)
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Default Re: Question about diagnosis?

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2 different things altogether though both are found in ALS and, of course, other medical conditions
Right, but you said I mentioned he had clinic weakness? I said he does not have clinical weakness. He passed his strength test with a 5/5 in everything. I apologize I must have missed your earlier post. We have an appointment with the university of Miami for a second opinion. They have an ALS clinic there. As far as how my Dad is handling it....its very hard on him. He was not expecting the neurologist to give that type of opinion and he was a very cold doctor. It obviously really scared him. The fellow that was performing the EMG had to keep running out of the room to ask the neurologist questions about what she was doing. She also had an assistant there and she was saying "shouldn't you do this" I think this is what you do" things along those lines. The whole entire experience was a nightmare for him. It made him very nervous. The neurologist put in the report that he was there over seeing the whole thing, but he wasn't.
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Old 03-15-2014, 11:40 AM #39 (permalink)
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Default Re: Question about diagnosis?

When I said clinical weakness I meant the comment that was made during exam of one side seeming weaker. Do ask neuro 1 about the discrepancy. Either neuro1 felt it was not significant or neglected to change the defaults on his template for neuro exam. The latter happens on occasion. I was told clear atrophy during exam but the report said no atrophy.
Sorry about your dad's experience it sounds horrible and I am sure he was totally blindsided by the results

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Old 03-15-2014, 11:51 AM #40 (permalink)
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Default Re: Question about diagnosis?

Eric, let’s back up and see what we actually know…
UMN: The clinical exam performed by Neuro 1 found: “Neuro exam pertinent for tendon hyperreflexia and increased tone in the lower extremities.” These may be a sign of UMN lesions, but I believe there are dozens of potential causes of this finding. A lot (like a severed spinal cord) can be ruled out, but I don’t know that others like spinal cord tumor or stenosis have been.

By the way, Wikipedia says, “The most common cause of hyperreflexia is spinal cord injury…. But hyperreflexia can be developed via many other causes, including medication and stimulant side
effects, hyperthyroidism, electrolyte imbalance, serotonin syndrome and severe brain trauma.”

You said his MRI came back fine. What was this an MRI of? Lumbar, thoracic, cervical? In other words, has his whole spinal cord been examined for a possible cause of the hyperreflexia?

LMN: Next, “EMG/NCS: The electrophysiologic findings are suggestive of a widespread disorder of lower motor neurons with active axonal loss (fibrillations, positive waves) and motor unit irritability (fasciculations, cramps), evident more in bi lateral lumbar, and less in cervical myotomes. These findings can be seen in disorders of anterior horn cells or extensive polyridiculopathies. No evidence of myopathy.” Anterior horn cells are cells in the spinal cord. Polyradiculopathies are many radiculopathies, which are basically pinched nerves at the root (“radix”) which is at the spinal cord. And note that polyradiculopathies are not ALS. Could some other spinal condition, or two simultaneous conditions, be causing the apparent UMN and LMN signs? I don’t know, but have all spinal cord conditions been ruled out? (Can’t be ALS until everything else is ruled out.)

WEAKNESS: I believe you have indicated he has no perceived weakness and was 5/5 on all strength tests. This makes it not sound like ALS to my non-doctor mind, but we have to be careful. Nerves lose about 70% of their fibers before weakness is generally noted by the patient. So, yes I guess it’s possible to perceive no weakness and still have a dirty EMG.

Based on what you have stated, it seems to me the answer is a big INCONCLUSIVE. (Which in the world of ALS means--Not ALS… at least not yet.) So, I’d say don’t give up hope, don’t get depressed, don’t get anxious. Just move on to the next step… UofM or a similar institution. The diagnosis of ALS or discovery of the other neurological cause is a long journey. Journey on!
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Old 03-17-2014, 06:40 PM #41 (permalink)
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Default Re: Question about diagnosis?

So my dad went to the university of Miami today for a second opinion. The neurologist is very confident that he does not have ALS. He did a full physical exam and spent over an hour explaining to my dad what's going on. He doesn't want to re do any of the tests because he thinks it is un necessary. He does want to see him in 3 months just to make sure everything is staying the same. I want to thanks dusty and bluedog for your help. Thank you for the support and for helping me interpret the EMG results. Thank you everyone else who showed their support as well. I will keep everyone updated . Thanks again!
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Old 03-17-2014, 08:09 PM #42 (permalink)
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Excellent news!
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Old 03-17-2014, 08:11 PM #43 (permalink)
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Default Re: Question about diagnosis?

good news is good news. rejoice.
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Old 03-17-2014, 09:17 PM #44 (permalink)
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Default Re: Question about diagnosis?

That is awesome news! Happy for your Dad. Sounds like maybe he has BFCS instead of ALS? Did the neuro say what it was? Anyway, hoping his foliow up will show no progression. Thanks for posting what the ALS neuro said.
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Old 03-18-2014, 08:28 AM #45 (permalink)
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Wonderful news! Thanks for sharing it with us
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