MRI Suggestive of What?

sure I posted them to try to back up what Shaw was saying.here are the numbers and below is the link to the article and the table they are taken from ( hate not to include my source). These figures are cases.... so for example if we take age group 40 -44 and we look at females, we can see that over a 2 year period 14 females out of a sample population of 1.5 million similar woman were diagnosed as having spontaneous ALS. ( i.e. these figures are not for the inherited form). AGE MALES FEMALES40-44 MALES 24 OUT OF 1,693,896 ( i.e out of . 1.7 MILLION) FEMALES 14 out of 1,710,534 45-49 MALES 35 OUT OF 1,565,127 FEMALES 23 OUT OF 1,582,262 50-54 MALES 38 OUT OF 1,606,043 FEMALES 37 OUT OF 1,615,772 55-59 MALES 77 OUT OF 1,348,148 FEMALES 39 OUT OF 1,385,152 60-64 MALES 72 OUT OF 1,280,496 FEMALES 79 OUT OF 1,367,302 65-69 MALES 95 OUT OF 1,098,073 FEMALES 84 OUT OF 1,261,865 70-74 MALES 96 OUT OF 900,352 FEMALES 76 OUT OF 1,170,278 75-79 MALES 63 OUT OF 649,547 FEMALES 69 OUT OF 990,265 Here are the links Take care Hx ... /table/T2/

Tdenver,you are a good example of what our perception makes to an information coming in. so you have fine reflexes, slight abnormalities on EMG (which many of us have, me too for example, and arm could be affected due to ulnar nerve compression, EXTREMELY COMMON nowadays due to PC usage, and back due to lumbar issues), and your prevailing clinical symptomes are progressive slurring (however intermittent) and general fatigue plus brainfog. to be honest first idea is to check whether you have really any recent infection (not always have to be acute), viral or bacterial (especially Lime disease). Lime disease may result in so called pseudobulbar sydnrome in which people do have slurred speech etc. Considering your age and general low rate of pure bulbar ALS , and even least and probably close to zero possibility to have bot bulbar and limb onset (especially both in upper and lower limbs) - I would rather think that you may really hope on neurological issues related to neuroinfection.nonspecific findings on MRI should be treated as they are - as nonspecific lesions. maybe they appear due to some infection, maye they were there forever. Anyway, MRI usually shows changes in WHITE MATTER, or myeline sheath of the neurons, while in ALS problems, as far as I understand, happen to GREY MATTER, and for example for diseases like Parkinson or Alzheimer it is possible to see a decrease in bulk mass of grey matter but those changes harldy could be called non-specific I think.Wish you to stay strong and have my best regards and my thoughts with youYulia

Edit-I misread your reflex exam. I thought you said you had abnormalities. Good reflexes is encouraging.

This is what my MRI says verbatim, " There are symmetric areas of abnormal signal in the foramina tract on both sides extending from subcortical white matter down through the internal capsule regions and into the cerebral peduncles and into the pons. These findings are supportive of a diagnosis of als" Question. What does bulbar ALS look like at first. I can get through some conversations with no slurring, so that's what confuses me. My Doc ran a hosts of test and lyme is one of them. I just got back my Creatine Kinase results and it was high, in the 300 range.Thanks Shawn for your messages and knowledge sharing, I really want to get to the bottom of this. Without my prodding the doctor would have shrugged this all of to stress, which by the way I'd be fine with as a diagnosis

A cpk of 300 is not a high number Many of us have had that and much much higher Take a few weeks from any activity and take it again

It was 375 to be exact, but again I don't "feel" any muscle atrophy, I am still doing high impact martial arts?

The normal range is 0 to 300 Many things impact this number including size injury working out and timing Take 2 weeks off everything and I mean everything and take I again it will go back down Or better yet work out to 80% of your max then take it right away then take it 2 days later then take it 2 weeks later That will give you a much better result and help you detemine recovery This is a max cpk test

Mine was 900 - 1100 20 years ago, it's slowly lowered to 500 over 20 years.You may have something that they ain't identified yet. Wait it out, if you can't do something, like turn your ignition in your car, hold a gal of milk, etc. that you could do before, seek help, other than that...stay away from the crap doctors you are seeing.Ridiculous suggestions with only 3 mos. of symptoms and no clinical weakness..............irresponsible, your doctors should be reported.You are in panic mode

Hi again,I hope you are doing OK and hanging in there. What a mess for you to be dumped in. You said your main problem was slurring, some muscle disorders make it difficult to use or control the muscles of the mouth, tongue, larynx, or vocal cords, which make speech difficult. On clinical examination your neuro said you seemed to have specific problems with the speed of moving your tongue back and forth ( it was clinically weak). I guess with these symptoms he will have naturally EMG the tongue at the same time you got the limbs done. ( normally like a needle under chin). Did that show up any damage, or was it just your back and arm. If it has not been done then perhaps you could ask for his opinion on this.Keep strong and remember you are not alone. I really hope this resolves for you soon.Hx

Tdenver,for a person doing high impact martial arts CPK 375 is really nothing because it increases incase of physical activity especially if you are hit - becasue some muscles are physically destructed and CPK gets into the bloodstream. Usually people doing high impact martial arts may have way much bigger CPK just because of traumas. So your level is absolutely OK.As you can see, we have fellows here who had triple times upper limit CPK and still no MND (however three times upper limit is of course a reason to worry).CPK increases due to physical activity, stress (which involves involuntary muscle activity), infection - about in the range like yours, some drugs like statines can increase it significantly (up to the level which may cause worry).by the way, do you take any medication chronically or for prolonged times?

Hey bud, I am curious which symptom prompted all this originally? What made the doc decide you needed tests and to see a neuro and all this stuff?Thanks.

From September to December I was extremely tired and would slur my words after only a few drinks, so my wife insisted I go see her neuro. Those were my only symptoms. Fatigue and alcohol intolerance aren't to my knowledge symptoms of MND which is why I had a hard time getting anyone to listen to me. Over the next month fasciculations started and then cramping.

TDenver,ALS usually starts in limbs (most of the cases) or bulbar (25% of the cases). Fasciculation is usually not the first symptom. In limb onset it is true weakness caught through a clinical exam (with a normal speech in the beginning.) While in bulbar onset it starts with a slurred speech usually noticed by others (with no limb weakness in the beginning). Cramping can also be an early symptom, but here we are talking about repetitive and very painful cramps in unusual places. I thing every human being on this planet cramps a few time per year.You had clear bulbar issues followed a few months later by muscles twitching. Yet, your case seems a little bit weird. I am not a doctor, but usually bulbar onset ALS has a fast progression. If your symptoms (slurred speech) started in September, then now after 7 months you should have been totally unable to speak. Also you are young, ALS is rare and Bulbar ALS is even rarer. Many things can provoke bulbar issues beside MND. Some other degenerative diseases, some inflammatory diseases, genetic diseases also, tumors (malignant or not), toxic issues, vascular issues, viruses and autoimmune conditions. Regarding autoimmune diseases, slurred speech is often the first sign of Myasthenia Gravis. Fatigue is the hallmark of this disease. You have both symptoms. Anyway, you seem to have a proactive attitude toward your condition by doing all the necessary medical exams. I really hope it is something else than an MND, and I think you have good chances for it not to be an MND, but only your doctors can say what it truly is. My thoughts are with you, and keep us updated.

Shawn87, just adding a few points:1) It is not that unusual for MND weakness to fluctuate slightly (in the beginning) and actually quite often it is better in the morning when the surviving neurons and muscle bundles they inervate are not exhausted. Sometimes this is even enough to make us think about myastenia gravis. So some level of wax and waning does not exclude MND.2) MRI is really usually useless, although an experienced radiologist might recognize changes typical for motor neuron diseases. However, it is not common to see these in the early course of the disease.3) Duration of bulbar ALS might or might not be rapid. Depends on the severity of tongue and throat muscles involvement. I have seen a girl (who passed away 4 weeks ago) diagnosed at the age of 18 and this year she would turn 25.TDenver, what areas were EMGed? The crucial question here is the presence of tongue fasciculations, be it clinically or on the EMG. Do you have any upper motor signs?Myastenia gravis would be possible but the EMG would show different reading. I hope your EMG was false positive, it does happen!

All the input and replies here are really overwhelming, thanks to all!I am my best at night. In fact last night my in-law's came to visit from another state and they said they didn't see or hear anything wrong with me. Also I told my counselor of the MRI results and he said he's never heard me slur. So I guess the "slurring" could be emotionally triggered. I do feel a slight tightness or heaviness in my chest sometimes throughout the day. When I feel like I slur, it's more like my chest or lung muscles are tired and I can't project my speech, so perhaps the "slurring" is related to that. I also have a changes in my laugh. It's hard to explain but it feels like my chest is tight when I laugh, and i notice it because I laugh a lot!

I've stopped drinking because It made me feel really horrible. I used to have a high tolerance, but now I can't have more than 2, and even with that it make me anxious. I know what you are saying about "slurring" it's more like taking notice to certain sound...

I must note that alcohol intolerance also is common in our fellows. It may indicate that either you have a constant excitation focus in the brain (as many of us seem to have) so need much less dose to get physical effects... or it may indicate also chronic intoxication, at which it is well known that people need much less dose to get physically drunk compared to their previous experience. Practically it also may happen as post-viral effect, maybe becasue of increased permeability of the barriers and membranes. I am not sure if MND victims report alcohol intolerance, even those who have a period of cortical hyperexcitability, as in ALS.Good sign is that you feel better at the evening, at night and at home. There is a type of mood disorder at which people feel better at the evening (I belong to them by the way, and for years mornings were my worse hours).As for tightness in the chest, this definitely belongs to anxiety realm. It comes becasue of hyperventilation. If you slur at the same time as you feel tightness, this even more may point on anxiety issues.To have this effect, people should not always feel themselves like they are on the hot pan. Hidden stress which we are used to think manageable or even do not notice, acts in the same way.So go through all tests (please consider that lime infection is hard to spot unless it is not fresh, but the damage might be revelaed only later with the time, so never consider this option 100 % discarded if initial test is negative), ask for bulbar EMG which is crucial in case of symptomes possibly related to damage in the bulbar region, look for second opinion on your MRI or get the scan with higher Tesla apparatus (more resolution) and generally consider that chances to have rare subset of rare disease in the age group well outside of typical stats are close to zilch. Our fellow TwitchyMD of course had mentioned 18-years girl in his comment, but I think you are too old for that subtype of ALS already.

TDenver, you haven't mentioned it as a symptom but I'd like to ask if you've had pain or other sensory issues (numbness, tingling, buzzing, etc). By the way, It is good and inspiring to hear that you laugh a lot

Hii ShawnYou were asking about studies. There are changes on MRI in AlS, but they are not considered to be reliable either diagnostic or prognostic as they are not known to be specific. As far as I know MRI's sole role in the diagnosis of ALS is to exclude other causes for presenting symptoms. (Perhaps the neuro had questioned ALS on his notes and the radiographer was using the scan to say he cant see anything obvious to contradict this opinion, rather than saying the scan shows ALS). The article I linked on page 2 of this post has references to many imaging studies characterising specific ALS phenotypes or genotypes.Article called ' Lessons of ALS imaging pit falls and future directions. If it doesn't link I can email you it. Though suffice to say it is not the most easiest article to read. Bit like wading through mud on a rainy day.HxPS sorry about the terminology for those in different fields. In the context of the disease refering to ALS ' Genotype ' refers to the genetic make up, and ' phenotype, talks about physically how it presents.

I think Yuli is right about further emg. I am at a bit of a loss why your neuro didn't do this as he observed weakness in that area and your tongue was not moving fast enough to pass the clinical, why did he not investigate. A lot of us have had this done based on less defined symptoms........Shawn sums up when he says MRI may be radiographer taking non specific findings and making them specific. It is possible. I guess what posters are trying to do is help you see that it may not be all you fear. Ultimately it is your neurologist that is qualified enough to call it one way or another, but at the moment there are still many open doors, and lots of them lead to places other than mnd, some may still lead to bfs.Thoughts are with you, hope some of this has helped.Hx