Abnormal EMG & NCS, Normal MRI

[lion]

Hi, I had abnormal NCS and EMG with findings of left L5 Radiculopathy, moderate TCS, EMG done in all extremities with diffuse distal denervation consistent with polyneuropathy and focal denervation in the tibialis anterior muscle. NCS showed slow motor nerve conduction in the 4 nerves tested (median, peroneal, tibial, ulnar) and also sensory in the median and ulnar.
The neuro ordered an MRI of the L5 and after a month I went to the neuro again yesterday, and received the MRI study of the L5: it came normal. So now I m more concerned than before since EMG is abnormal with a L5 left radiculopathy but MRI is normal. Im totally lost now. If I had radiculopathy due to the EMG finding but nothing in the nerve root since MRI is normal...maybe something more serious? Im still worried about having an early stage of ALS...I really would like to hear your opinion. The neuro discarded that but was not able to give me a clear explanation...What should I do next? Is it possible to have normal MRI and radiculopathy at the same time? due to what cause? Thanks again for you support

 

[Nikki J]

Your ncs was abnormal. That is not the case with ALS. This is something else. It is up to your doctors to figure out exactly what

 

[lion]

Thanks Nikki for your quick and kind response. Two questions:
1. A bad NCS even mainly motor rules out ALS?
2. I do not understand why I have the tibialis denervated with fascics and according to the EMG L5 radiculopathy but MRI went back normal. Could it be realted to something in the horn cells? Do you have other possibilities that comes to your mind?
THANK YOU again and sorry for the questions

 

[Atsugi]

Lion, you're trying to get pretty specialized medical answers over the Internet. Not a good idea.

 

[lion]

Well, you are right Atsugi, just wanting to know if anyone can give me a clue about this since neither my neuro responds anything nor finding info on the internet about this issue of having EMG showing L5 and then the MRI came normal. Thanks anyway for your comments and sorry

 

[GilWest]

ALS is a diagnosis of excluision. All other possibilities are still out there. Don't worry and let your doctors do the diagnosing...

 

[lion]

Yes, Gilwest, I know that, but just wondering if this finding (or not finding anything with the MRI of the L5) is still within the scope of polyneuropathy or another thing. Thanks for your comments

 

[Atsugi]

Lion, our smartest member, Nikki, has already answered your concerns. I quote "this is something else."
You need to work with your doctors and stop wasting your/our time here. We only do ALS here, and your test results show something else, not ALS.

 

[lgelb]

Lion, you're in a city with UT, Baylor, Methodist neuro clinics -- all stacked w/ expertise -- hit one up. If you already did, forward your notes, tracings, reports and films to another, whoever's in your plan. Nothing you've pasted from the rpt says motor neuron disease. But, short story, MRIs and nerve testing can disagree for good reasons, most of them not catastrophic. You need to find a neuro who can communicate, and give you a definitive answer. You won't find that here. All the best.

 

[lion]

Thanks to everybody for your posts. And agree that I should find another Neuro, he is not giving me any answer and after 5 min meeting with him (or even less) he stands up and leaves the office and I have to follow him to the reception area and finish my questionnaire there...not really professional. He mad it twice and its really disgusting talking in front of the three recepcionists about my doubts and concerns. Next step is to find an Institute like Baylor or similar...to find out what is wrong. Again thanks to everyone and my apologies for having taken your time on that