MRI Suggestive of What?

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When talking to my wife yesterday she did say the neuro mentioned that there was abnormalities in my neck/cheek, so I guess that could mean tongue? I am not sure if my tongue fasciculates, i guess it does but it's not overwhelmingly obvious like my arms are. My Neuro did say my symptoms are atypical so other things are possible, the other odd thing is that my GP ordered the MRI, not the Neuro, he was hesitant as he said it wasn't a good indicator, but my GP did all of the other tests and i pushed him for it. The symptoms listed on the form prior to the radiologist seeing it were fatigue, fasciculation's, dysarthria so I can see how he had some preconceived notions. I have doctor friends and I am going to ask to see if they can have another radiologist take a look at it with no preconceived notions.
 
Tdenver,abnormalities in the neck/cheek are not the same as bulbar one.bulbar EMG is done by inserting a needle into glottal nerve (under the chin) and looks for specific issues in the glottal muscle caused by deneravtion and degradation in the bulbar regions of the brain.looks like you did not have that type of EMG yet...neck problems are extremely common due to bad posture, and as you are a martial art man, you may have a lot of whiplash kind traumas causing abnormalities on your neck EMG.GP could order MRI just becasue, you know, just becasue it is considered as good diagnostic tool and is covered by insurance I think.to be honest, should I be a radiologist and see such a list of symptomes, I would also find something on your MRI "supportive of ALS'. I think it was preconsieved.instead you have other symptomes, not supportive (at least not typical) for ALS - like no clinical weakness yet, intermittent dysartria coulpled with symptomes of hyperventialtion, brainfog (really not so much reported in ALS people)... definite link to a daytime... rapid onset of widespread twitches (which is extrememly common for benign syndrome and not common for ALS)...normal reflexes...suppose the fact that your wife has MS may be enought to make a constant stress too to contribute to your condition:(((fatigue in ALS people is reported to be so strong that they barely could walk or rise the hands even before clinical weakness - and you are able to do martial arts! I was doing aikido when I was at your age... and holy crap, should I have fatigue, I would never ever step on tatami not saying about doig that relatively mild ans swift MA...definitely you need more clarification on your test results.wish you and your family a good luck on that wayYulia
 
Thanks Yulia! I agree, a lot of these things don't add up. I do know that every ALS case is very different, especially with presentations in young people. This forum brings me much need clarity when trying to make sense of it, if you just start googling it can get very bleak.
 
Your GP was right to do the MRI to rule out stroke etc . I worked with a guy for 5 years ( he was about 42), who slurred his words. He had developed an adult onset muscular dystrophy which was mild, never really progressed (he still presents at seminars), and will not shorten his life expectancy. It was either oculopharyngeal or FSHD dystrophy. Something like 90% of this type of disorder in adults is mild, but does cause slight weakness in shoulders,arms, and facial muscles. None shorten lifespan.I am only mentioning this because to some of us stuck in the ALS fear cycle, symptoms like man above would have finished us off. You seem quite balanced in your attitude to your news. Your strength is an inspiration. I am glad you have some friends in the field that can help you., and hopefully this nightmare will be over soon and you can get some peace and on with your life.Take care of yourself. Everything crossed for you, except my eyes cause they are twitching like crazy tonightHxxx
 
Ok I got my emg results back, they are rather long so I am going to summarize the abnormalitiesRight ulnar motor nerve conduction study was abnormal with amplitude of 7.8 millivolts distal latency 3.3 ms, conduction velocity 51 meters per second and F response 27.9 msEMG of the right mid-thoracic paraspinals demonstrated rare fasciculation potentials and positive sharp waves.EMG of the right genioglossus demonstrated mild chronic reinnervation although muscle relaxation was unable to be achieved to assess for spontaneous activity. Not sure what all this means but according to the records is "suggestive" of ALS?
 
I'm not an EMG expert, and hope to defer to those more knowledgeable. But, from my limited understanding of EMG, none of those things are exclusive to ***.The chronic reinnervation was the most interesting to me. I would think logically chronic reinnervation would happen later in the course of the disease...and if that were the case you would see significant loss of function...but your friends and counselor haven't even noticed you slur.Positive sharp waves can be indicative of many things...considering you are in karate...trauma can cause positive sharp waves.For me, when reading the MRI and seeing the EMG results coupled with your history...I would look further but I would be wondering if we had scanned your head 2 years ago would it have shown the same thing? Possibly. I wonder how long your MRI has looked like that. Possible old viral brain injury? Possibly.
 
Shawn87:Explanation to your questiont (not saying it is TDenvers case): Reinnervation appears very early and is actually the reason why patients notice weakness when there is more than 50-80% motor neurons lost. The slower the denervation, the more damage can be compensated for by reinnervation. That is the reason why can have only 30% motor neurons remaining, fasciculations but subjectively there is no weakness - it is well compensated. But EMG will spot it easily.The genioglossus muscle is inervated by the nervus hypoglossus (this is bulbar area), the nerve controlling the tongue movement and hence the finding here might explain your slurring. Chronic reinnervation would point to axonal loss.Good thing is that no fibrillations were recorded, there is no mention of on-going denervation. While the EMG is concerning, I would not limit the diagnosis to MNDs only (but of course I am not a MND specialist).
 
Hey TDenver, you also mentioned cramping? How long have they been around for and how do they effect you? Are they extremely painful? Do they last long? Are they all over or in a specific muscle?Also for the twitching, what is it pattern? Is it just body wide or in a specific place?This does seem like a really odd presentation for MND to be quite honest. It's all over the place with symptoms that don't even seem related.
 
My wrists cramp when i bend them and my jaw when I yawn, thought neither are painful. My #1 complaint is fatigue, I can hardly stay awake, but sleeping is hard too ;) I feel like I've been hit by a train which is why I think it's an infection. I can still do everything physically, my muscles don't feel tired just my brain.
 
Thanks. I have an appointment pending with a lyme specialist. I am not impressed with my neuro, last month he thought I was crazy for asking for an MRI, and this month he thinks I have als. Is extreme fatigue a symptom of ALS? I can't seem to find this anywhere?
 
As far as I know from at least one of MS affected persons, extreme fatigue is a sign of MS too. In ALS fatigue might be strong but usually in short time (weeks or so) it results in clear weakness etc. And it does not involve brainfog as far as I know, it is not a sleepiness - just a lack of willing to move or feeling that the move is extremely hard.One of my blog freinds told me about her son who was 22 - the boy spent few month literally laying in bed, he was sleepy, he might be quite absent for 20 hours per day, he almost lost his university grade, and the family decided to bring him to doctros only when he lost a vision on one eye. he was promptly diagnosed with MS, got a treatment, and recovered completely, graduated from university and works now as a stage artist in the theater...from your EMG one might probably decide that you have common issues with the ulnar nerve (who has not?). probably some trauma in toracic region and signs of once happened denervation now restoring in your glottal nerve. TwitchyMD, who is a pathoneurologist and one of the best eductated in the field fellows here told you may have axonal loss in that nerve which may rather sound like local deficite for me (like after trauma or infection)...I strongly support your idea to seek second opinion and maybe more specific second bulbar region EMG to see what is going on in your genioglossal muscle. Pseudobulbar syndrome is much frequent than bulbar ALS... by the way it also happens in MS and in several other autoimmune conditions, including Gullian Barre mentioned in the link in the above post (where the fellow twitcher had two denervation signs on EMG, lately reveresed.as far as I understand the idea of ALS clinical picture, you still lack clear and specific evidences. So do not give up.
 
I'd be leaning towards getting a second opinion. My uncle had progressive bulbar palsy which is bulbar onset MND from diagnosis to death was 14 months. First symptoms were emotional liability ie he'd find bad news funny and good news sad. Drooling started , followed by soft slurred words and loss of grip. He was still able to walk a week or so before he died of respiratory failure at 52. Hope you get sorted soon as being in limbo is not ideal and the stress will be causing your initial symptoms to go into overdrive.Got my fingers Xed for you for good measure ;)
 
No news other than I have low copper levels so we're running tests on that. Still waiting on my dna test to rule out Kennedy's. Also have an appointment with Mayo next week which is good. My Neuro is very thorough so some tests are still pending, and new ones always creeping up! Glad I have a good doc and family support system.
 
Ok jumping in on this with probably not much helpCouple things. Had a buddy that started to waste away for years. ALS was the only thought However after getting treated with hemoglobin he has made a tremendous rebound,...your symptoms sound alike. Lots of facial issues. Turned out to be myasthenia gravis .. Have it testedMet a guy at a gym who's son was waisting away with a virual infection that that left him bed ridden. It started in his face and moved all over. Slurred speech, other issues. Eventually he even had a trac to eat and breath, I did not get the name of the disease but again the son was pumped with hemoglobin and started to make a miraculous come back. He is now back to wok and fairly normalSorry no moreinfo. I will research it moreKinda tired
 
Kennedy disease is one of the options, and it does not decerease longevity which is good of course...as for low Cu... Didn't you have any recent visceral symptomes (pain in the belly, vomiting etc.)? Any signs of hepatitis (physical or analytical, like hepatic enzymes too high)? Low Cu in the serum might be associated with so called Wilson disease (toxic hepato-cerebral dystrophy due to disruption of Cu methabolism), it might have neurological presentations, but seems like not exactly like yours (more like tremor, agitation etc.), however it might include brain structure damages visible on MRI (not sure if your abnormal zones are consistent with those mentioned in Wikipedia article). On top of tremor, WD inculed loss of fascial mimical activity, loss of voice tone, etc. - again not exactly what you report.
 
Yeah I was pretty tired when I wrote that post. Kind of buggered it up. I went back and cleaned it upI am not an expert at all but this just does not sound like an MND. It is moving to fast. Has to be a virus or something like Lyme. Keep getting testedIf I see that guy at the gym I will ask the name of the disease DD
 

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