Can be ALS ?

[davy_32]

Hi I’m Davide from Italy , 30 year old . I’m testing for ALS . I have weakness in arms and legs , cramps, difficult to breathing , very high pulse , difficult of digestion , weakness in general. Lose weight (15 kg )
I did all these exams

Sensory-motor conduction parameters are normal. The coaxial needle electrode examination (muscles examined: hyoglossus, right I interosseus, tibialis anterior de and vastus medialis left) does not highlight signs of primary myogenic or secondary neurogenic suffering in the motor unit potentials of the muscles examined. Upper limb motor evoked potentials The latency of the cortical components and the central motor conduction time bilaterally are normal (7.5 msec right, 7.6 msec left). Lower limb motor evoked potentials The latency of the cortical components and the central motor conduction time bilaterally are normal (9.9 msec right, 9.8 msec left). Cortico-bulbar evoked potentials The latency of the components examined bilaterally was normal. Somatosensory evoked potentials of the lower limbs. The latency of the cortical component bilaterally is normal.
EMG at legs and arms negative
Doctor of neuromuscolar department asked bulbar and paravertebral districts but hospital didn’t check
I also did MRI HEAD and neck negative
Xray of chest negative too

This was the neurological exam
patient alert, well oriented, cooperative, undamaged cranial nerves (eyelid myokymias and doubtful lingual hypotrophy are reported), does not lose height in Mingazzini on all 4 limbs where tone and strength are adequate, bilateral leg and palmar hypotrophy, lively and symmetrical ROT on all 4 limbs with a tendency to polyphasia in the AAll and widening of the reflexogenic area, superficial sensitivity and normal coordination tests on the 4 limbs, well-maintained upright position with eyes open and closed, walking well performed independently with eyes open and closed, possible on tiptoe, difficult on the heels. Hoffman and babinski negative .
Can someone help me please !!

 

[Nikki J]

What did your doctor say? It doesn’t sound like ALS. As far as I can see your abnormalities on the exam were difficulties in heel walking ( can you not do it at all? Both sides equally affected?) and bilateral leg and palmar hypotrophy ( your whole legs are smaller??)

I realize this is a translated note but it is written in a way that is hard for me to understand. However ALS is not generally bilateral in onset and the weight loss, digestive issues and high pulse argue for another cause, perhaps something systemic

 

[lgelb]

The note says that you do not have myopathy or neurogenic disease, so I agree that the cause seems more likely systemic and I would coordinate with your GP. I would make sure your thyroid and other hormone levels were tested, along with electrolytes and inflammatory markers such as ESR and CRP.

If a 24-hour cardiac monitor reveals that your pulse is high on an ongoing basis, I would make sure medication to reduce it (and perhaps your blood pressure) is discussed as well.