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andrewdunn

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Thank you in advance for reading my post and apologies if some of my questions are not consistent with the sticky notes.

I am 27, male. For the past four months I have perceived weakness and feeling of numbness in left arm and leg which tend to come and go. The numbness is usually more persistent in my leg. The leg also feels tired quite often when I walk. I also have widespread twitching since the symptoms onset which is also not always present. The symptoms doesn’t seem to progress for now.

I had an EMG which was clean back in October. The neuro told me that my reflexes are a bit brisk but nothing to worry about.

Now in December I decided to go to a reputable clinic and have more tests done. Had another EMG which was clean as well. Blood test also came back normal.

All of the three neurologists performed a neuro exam and their conclusion was that I have normal gait.

However, according to the report I also had assymetric reflexes, more briskier on the left side of the body. This was especially the case for the knee reflex on the left where the reflex is said to be polykynetic (I think this means couple of muscle contractions). I asked one of the neuros and he said yes it is more briskier but nor pathological because of the reflector zone( no idea). Hoffman sign was positive and plantar reflexon the left is negative (but the report says a bit weak or oppressed, depending on the translation). No sensitivity issues.

They said it is absolutely nothing to worry about and it is probably mainly due to anxiety. One of the neurologists was more worried about MS but the other said is very unlikely. They said I can do an MRI for peace of mind to rule out MS or pinched nerve, but to me it seemed more like they don’t believe it at all.

I am confused because the opinion of the neuros is consistent but isn’t assymetry always abnormal (also Hoffman sign +). I am afraid that they neglect it because I am young. It can’t be a coincidence that reflexes are not normal on the left side where my symptoms are present.

My questions is, do you think it could be ALS starting with UMN (which they just exclude don’t mention for some reason ) and it is worth further investigation or just leave it as it is ?

Thank you in advance and have a nice holidays !
 
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Three normal exams, two normal EMGs...as you know, numbness is not an ALS sign and would be more consistent with MS or a pinched nerve as your docs have mentioned.

Asymmetric reflexes can be normal variants and a positive Hoffman sign can be down to anything from anxiety on up, as the neuros probably mentioned.

But in terms of UMN-dominant ALS, which you are asking about, you haven't described anything that would lead me to think of that.

So on the basis of what you've said, their lack of concern makes sense but if they are offering an MRI to help rule out MS or some other nerve issue, sounds like it would give you more peace of mind.

Best,
Laurie
 
Laurie, thank you for the reassuring words !

To be honest, I have read that assymetrical reflexes and positive Hoffman are consistent with upper motor neuron lesion. The fascics also do not help...Also, I think I have read that some people with ALS experienced numb/weird feeling in leg as a symptom onset and came across some posts regarding PLS. Given that I don’t have your experience and their knowledge, I believe ALS is not an option here.
 
The case presented is really quite clear. First, Andrew, you say (quotes are mine):
“perceived” weakness
“numbness” in left arm and leg
which tend to “come and go”
leg also “feels” tired quite often
“widespread” twitching



Those are all excellent signs leading AWAY from ALS. ALS doesn’t do “any” of those things.


NOTE: When a patient reports a symptom, that particular symptom might not be caused by ALS, but you’ll see it in their list of symptoms. For example, if I tell a doctor I have a runny nose, and then we find Deadly XYZ in my brain, we should be wary when reading a website that says “People with Deadly XYZ have reported runny nose.” Sure, it’s reported, it is a symptom (of something), but it’s not necessarily connected to the current problem.

Next, Andrew, you have good, gold-standard testing giving objective data with a conclusive answer:
EMG was clean in October.
The neuro told me that my reflexes are…nothing to worry about.
another EMG was clean.
Finally, you’ve been reassured by the experts who actually examined you.
First you were concerned with brisk asymmetric reflexes and the neuro told you this was “non pathological and also “absolutely” nothing to worry about.


Looks like you’re really, fully, totally cleared. You have NO kind of MND.
 
Hi Make,

Merry Christmas ! I do really appreciate you opinion, it is quite reassuring. The only thing that stil worries me, do you think the stiffness/numbness in my leg could be UMN predominant ALS and they miss it because it is too early ? Sorry if I am getting annoying :(

Thank you !
 
Numbness is not a symptom of ALS. The stiffness you see in lists is either a late symptom from immobility which is clearly not you or a reference to spasticity which is easily detected on a neurological exam so you don’t have that either

Enjoy your holiday!
 
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