- Sep 4, 2008
Hello all I am a newbie here, My name is Lori and I am 41. my husband Andy also 41, is having ALS symptoms. My husband had a first cousin to die form ALS at the age of 34.
To start off with, we went to our family doctor so they could refer him to a neurologist. They took a lot of blood work at the family doctor, and blood did not come back good, his liver enzymes was extremely high. So they took it again, and it was still high. Well to make a long story short, He goes to the neurologist, and she done the physical testing on him, and his whole right side is a lot weaker than his left. He is right handed so this is not good, should be stronger. She done more blood work ( B12, a CPK and Aldolase blood test) and again tests not good, his liver enzymes was still high also his muscle enzymes came back very high. So the first testings she did was a brain and neck MRI, that turned out good. So she set up an appointment a week later dr did EMG & NCV test.
The EMG & NCV findings where as follows:
All nerve conduction studies were within normal limits. All F wave latencies were within normal limits.
Needle evaluation or the right AnTibialis muscle showed increased insertional activity and slightly increased spontaneous activity. The right MedGastroc and the right L5 Parasp muscles showed increased insertional activity. All remaining muscules showed no evidence of electrical instability.
Impression: Normal Nerve conduction studies of the right upper and lower extremity. No evidence of neuropathy. No evidence of myotonia on EMG of the right upper and lower extremity. Mildly increased insertional activity in the muscles of the right lower extremity with normal, to small sized motor unit potentials. This is a non specific finding, but in this clinical setting may suggest a mild myopathy. No evidence of motor neuron disease/ALS by todays electrodiagnostic testing.
So the Neurologist told him he would have to do a muscle biopsy. So we had to go to another Neurologist that does surgeries, and Andy had the muscle biopsy 2 weeks ago. The surgery went well, they did a 3 1/2 cut on his right upper quadricep. They told us it would take one month for the results to get back.
Well we go to back to the surgeon yesterday to check incision. Biopsy results are now back here are the results:
Final Diagnosis: Chronic denervation and reinvervation.
Here was the microscopic description: Frozen and formalin-fixed sections of skeletal muscle are stained with H&E. Frozen sections are stained with Gomori Trichrome, oil red O, PAS, SDH, ATPase ( ph 9.4, 4.6, 4.2) NADH (DPNH), COX and acid phosphate. These show preservation of fascicular architecture without perifascicular atrophy or increased connective tissue. There is mild variation in fiber sizes due to scattered atrohic, angular type I and II fibers. The NADH reveals no target fibers. Internal nuciei are not increased. There is no no chronic or acute inflammation and the Gomori stain reveals no definite rimmed vascuoles. SDH and cytocrome c oxidase reveal no definite ragged blue equivalents or negative fibers. ATPase histochemistry reveals collections of type I and II fibers touching on all sides and more than 13 touching type II fibers. PAS and ORO reveal evidence of excess storage product. Acid phosphatase activity is not increased.
I'm not sure what all that means, maybe someone in here might have and idea what this all means.