Need Clarification

[sigmund898]

Hi! I am a 25 year old Male,I have been experiencing Unilateral or One sided Palatal and Swallowing weakness on the left side only, along with Eustachian tube problem and a Stiff neck and Trapezius muscles also on the left side which has started about 1-2 months from now, tongue is also starting to feel heavy again on the left side , i do have diffculty speaking the right words sometimes,but that only happens rarely.Also slight weakness or tingling on the left arm and Leg that gradually gets better as the day goes on.

I went to a Neurologist yesterday, and confirmed my findings in the palate and neck and trap muscles except for the left arm weakness,and said that it was still very strong after a grip test.Gag reflex was also intact, I am having my MRI later this day.

I was just hoping to ask if Bulbar onset ALS can present itself as Unilateral/ One sided Presentation predominantly before affecting the other side? or is it both sides immediately that are affected,thank you

 

[Nikki J]

Interesting question. In my family members when they got bulbar symptoms they were not unilateral. I don't remember hearing diagnosed people describe such a pronounced unilateral onset either but maybe someone has?
My gut reaction is this is going to be something else but of course you need the tests to know What did your neurologist give as possibilities? Please do return when you find out and tell us. I pray it will be something treatable

 

[sigmund898]

Ill definitely come back after my MRI is done, thank you for finding time to answer my questions , at first I thought that is was just psychosomatic that everything i was feeling was on the left side until i inspected my palate because of the heaviness i was feeling. The best thing that could happen that my neurologist has told is that it could just be isolated nerve palsy and the stiffness in the neck and trap muscles was and impingment on the spine that just happened incidentally,other than that, i recalled he mentioned that i might have experienced a stroke or a TIA attack,however my age and Blood Pressure suggest further investigation of the specific cause, another is maybe i could have a unilateral lesion along the pathway of the nerves, and lastly but the least probable is ALS.

One thing I forgot to mention is last Ausgust 2014 i had an episode where I woke up in the middle of the night unable to move my eyes except down,they were unvoluntarilly looking down, and since i am alone at home at that time, i decided to just pray and sleep it off, amazingly when I woke up eyes were fine, however I did not notice any other deficits then such as in swallowing, stiffness on the left side until last november and the eye paralysis episode did not happen again.

 

[ECpara]

My husband's bulbar onset did not present this way at all, it was initially his whole tongue, later his whole neck. Also the fact you use the word "sometimes", and your weakness "gradually gets better as the day goes on" points away from ALS. Symptoms don't come and go, they don't get better, it's a progressive disease from start to finish. Hope you find an answer but it doesn't sound like ALS. Another thing in your favor is age. 1 in 1,000,000 chance of ALS under 30, the further from the 30, even less the chance, multiplied by 5 since only 20% of ALS is bulbar. So you're looking at mighty slim chances.

 

[sigmund898]

Thank you ECpara for your reply, it reduced my anxiety quite a bit , ill keep you guys posted after the MRI and lab tests, since the unilateral palatal weakness is really bothersome and confirmed objectively by the neurologist, compared to the limb weakness that i might just be feeling subjectively, again thank you for your replies

 

[sigmund898]

MRI results just came back clean,still same symptoms the last time,unilateral left palatal weakness and tightness in the same side of the neck, probably the laryngeal muscle involvement as said by the neurologist. and stiff trap muscles only on the left side again. EMG of the palate and tongue are next,though it will be a few months before it will be available

anyone else have input of the both sides and one sidedness of bulbar onset ALS?