Old 09-11-2018, 08:44 PM #1 (permalink)
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Default Neuro update

Had my Neuro appointment today few questions

My reflexes were brisk and I showed positive Hoffman's and my left thumb was 4/5 everything else 5/5 when he told me that I broke down is this normal should I be worried?
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Old 09-11-2018, 08:48 PM #2 (permalink)
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Default Re: Neuro update

Will, the question is, what did your neuro say? They're the one who examined you and dictate what direction to take next. Why are you asking strangers on the internet when you had access to a doctor who examined you in person and you could ask questions directly to about their observations?

I also bring a quote over from the last thread you had:

Quote:
Originally Posted by Nikki J View Post
I am closing this thread. Please do not post again unless you get a neurologist’s report indicating ALS ( In all our opinions you will not get this)
Do not post till you have a report in hand.
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Old 09-11-2018, 08:49 PM #3 (permalink)
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Default Re: Neuro update

Will,

Brisk reflexes are not out of the ordinary. 5/5? Lucky you; my husband is 0 out of 5 on his left leg. 5/5 means you have perfect strength. What is it that brings you here to ask questions that you didn't ask the neuro? What did the neuro say? Did you have an EMG? Was it just a clinical exam? Why are you breaking down over a disease you do not evidence? Seriously, why? Please explain as I'm not understanding why you're diagnosing yourself with ALS. Who told you you had it?
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Old 09-11-2018, 11:41 PM #4 (permalink)
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Default Re: Neuro update

Even with a positive Hoffman's test it means you have an injury to some spinal nerve. That's a long way from a progressive neurological condition. My neurologist has brisk reflexes. You have not been diagnosed with anything, let alone a fatal disease. You need to go back to your GP and explore why you feel you need to be diagnosed with the big one without having any weakness. 4/5 could just be asymmetry.

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Old 09-21-2018, 05:33 PM #5 (permalink)
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Default Re: Neuro update

Just nervous my Neuro wrote his Exam possible MND the brisk reflexes thought and positive Hoffman's I haven't had any spinal injurys. All my blood test were normal and my hands legs and forearm are tight twitching mainly in my legs not much and may spread from arms and back I don't have an EMG until next month
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Old 09-21-2018, 06:45 PM #6 (permalink)
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Default Re: Neuro update

Where did you see this written?
Are your reflexes brisk on both sides? What about the Hoffman?

Again what the neuro say?
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Old 09-21-2018, 08:00 PM #7 (permalink)
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Default Re: Neuro update

Brisk reflexes are very common, especially if they are bilateral. Stress can even make reflexes brisk. Some people just have brisk reflexes.

My neurologist has very brisk reflexes AND he has fasciculations in both legs. He isn't even concerned enough to have an EMG because he knows how common both these things are.
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Old 09-21-2018, 08:53 PM #8 (permalink)
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Default Re: Neuro update

On my exam report and I told him about my twitches and my Hoffman's was on both sides and brisk reflexes throughout EMG is Nov 9 or sooner with cancellation
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Old 09-21-2018, 09:08 PM #9 (permalink)
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Default Re: Neuro update

Bilateral relexes including Hoffman are more often than not a normal variant.

Possible MND was his written assessment without any other comments? Usually in a note there will be mention of differentials and discussion of the exam findings that are relevant And he did not discuss this or tell you anything at all?
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Old 09-21-2018, 09:13 PM #10 (permalink)
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Default Re: Neuro update

Thumb subtle weakness 4/5 facs in left hand
Said polyradiculitis and MND considered etc.
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Old 09-21-2018, 09:19 PM #11 (permalink)
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Default Re: Neuro update

Will, you’ve posted a lot lately.

ALS is a combination of upper and lower motor neuron abnormalities. You have described hyper reflexes and abnormal Hoffman’s test. These are upper motor neuron findings.

I went back through your posts and could not find evidence of lower motor neuron involvement, I.e. failure. Failure would be things like inability to stand on toes or heels, or inability to peel tabs off bottles or sign your name when you could do those things previously.

Diagnosis of ALS requires documentation of weakness by a neurologist in at least 3 of 4 spinal segments (bulbar, cervical, thoracic, lumbar). Characteristic EMG abnormalities showing denervation and reinnervation can substitute for clinical weakness provided structural lesions and mimics are ruled out.

So, you have not described failure and your workup is incomplete. No one can diagnose ALS in you at this time. Any speculation on your part in the meanwhile just fuels your anxiety.

Kindly refrain from posting until after your EMG.
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Old 09-27-2018, 02:16 PM #12 (permalink)
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Default Re: Neuro update

I'm just scared now what else can cause bilateral hoffman????
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Old 09-27-2018, 02:24 PM #13 (permalink)
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Default Re: Neuro update

Thread closed. Do not open another unless to report EMG results.
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