Does my dad have ALS?

[Vikman]

Hi everyone! So my dad has had weakness in his hands(cant button shirt, open jars, etc) since the end of last year along with very noticeable slurred speech. He saw all sorts of specialists and nothing was diagnosed. I included a link to his neurological report. It seems there are some finding consistent with ALS and others that are not? He has an appointment with a neuromuscular specialist at Yale Hospital in the coming weeks. To me it seems he does have it but would like to know what everyone here thought. Thank you for your time!

His neuro report:

 

[Nikki J]

I am unable to view the report. If anyone else can please let me know if there is anything inappropriate
OP sorry your dad is having issues. A neuromuscular specialist is a good step!

 

[Vikman]

Apparently the link to the report is broken here is the whole thing:

The patient is a 69-year-old male who we were asked to evaluate for muscle atrophy of his hands.

The atrophy is mostly below the elbows. He states that this came on about six months ago and has been slowly progressive. The patient is diabetic. He has experienced cramps in his legs; he has not noted any fasciculations.

The patient denies any family history of any similar problems. When this started he did not have any infections.

Cervical MRI was reviewed and did not show any cord pathology such as a syrinx.

On examination, the patient has atrophy of both arms which is fairly symmetrical involving the interossei and the lower arm muscles, including the FCU, EDC, extensors of the thumb. He is areflexic. Sensation is relatively intact.

The patient had nerve conductions performed on the Median Ulnar Peroneal and tibal motor nerves Median Ulnar Radial and sSural sensory nerves.There was decreased amplitude of the motor MUAPs, the sensory conductions and amplitudes were normal.

In the upper extremities, there is absence of proximal conductions, namely F waves.

In the lower extremities, again there is decreased amplitude of the motor conductions. There are F waves and H's present. Electromyograms were performed on both legs and arms. In the legs, done On the medial gastroc. Some fibs were noted but no real fasciculations. There was also a dropout of motor units. EMG of the Temporals muscle was normal.

In the upper extremities, there was evidence of again occasional fibrillations, no fasciculations. There is again MUAP. dropout.

IMPRESSION: The above is consistent with polyneuropathy.. It appears to be primarily a motor neuropathy. I do not see any evidence of fasciculations. The findings are consistent with peripheral polyneuropathy, more motor, such as Guillain Barre. It may be he has CDIP.A diabetic amyotrophy has not been ruled out.Itis usually proximal and lumbar. ALS has not been ruled out , however only a rare fasiculation was noted. The patient does need lumbar puncture for spinal fluid analysis. His MRI of the cervical area and brain were reviewed; there is no pathology that could cause these current symptoms.

 

[Vikman]

His blood tests were negative besides a very high CK. Spinal tap was normal expect for a slightly high protein level. CT scan were negative. There is some issues on the mri. Nerve impingement, spondylitis of the spine with disx degenerative disease and some dise bulges and neural foraminal narrowing.

 

[Vikman]

Sorry meant disc not disx/dise

 

[Atsugi]

Vikman, I wouldn't pretend to be able to interpret this report. Perhaps someone else can.
I also wouldn't want to second guess a doctor who has actually examined your father.
The report specifically mentioned four possibilities.
I see no reason in your posts to second-guess the doctor.
Nikki is right. The visit to Yale is a good step.

 

[Vikman]

Thank you for the response! Yes he did mention other possibilities but he also said ALS was not ruled even though he didn't really see any fasiculations. Its just his symptoms fit ALS as rare as it may be.

 

[Atsugi]

Its just his symptoms fit ALS as rare as it may be.

I wouldn't be so quick on that.

You and your family must prepare for any verdict, but it wouldn't do any good to say your dad is dying when you don't have proof of that.

Let the doctors finish their investigation.

 

[Vikman]

I wouldn't be so quick on that.

You and your family must prepare for any verdict, but it wouldn't do any good to say your dad is dying when you don't have proof of that.

Let the doctors finish their investigation.

You're right thanks again!

 

[Vikman]

My dad has had the same symptoms for about a year now. I know its different for each person but if he does have ALS would it have been likely his symptoms would have progressed?

 

[Atsugi]

My dad has had the same symptoms for about a year now. I know its different for each person but if he does have ALS would it have been likely his symptoms would have progressed?

Are these the symptoms that he has had for about a year now: "weakness in his hands(cant button shirt, open jars, etc) since the end of last year along with very noticeable slurred speech?

No way to tell. A person with rapidly progressing ALS could go from first symptom to death in a year. A person with slowly progressing ALS might not show any real change during a year. Still, it might not be ALS.

 

[Vikman]

Yes he has had those same symptoms for a year now.

 

[Atsugi]

Yes he has had those same symptoms for a year now.

Well, my wild guess would say that this would indicate that he probably doesn't have ALS. But really, we're just speculating, now. Hang in there, Vikman. Wait for Yale.

 

[Vikman]

Well, my wild guess would say that this would indicate that he probably doesn't have ALS. But really, we're just speculating, now. Hang in there, Vikman. Wait for Yale.

Thanks Atsugi. The wait is just very nerve racking and google definitely isn't helping :?:

 

[Vikman]

Sorry to keep posting but would the fact that the emg report didn't mention any denervations be something that would point away from ALS?