Dr. Ashok Kumar
Geriatrics
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Patient's Query
Hi doctor,
I want a review of electromyography (EMG) analysis to reassure it to be unlikely amyotrophic lateral sclerosis (ALS) onset. My knee and arm reflexes were normal, as were the strength tests. Does "good recruitment" in the presence of atrial fibrillation and occasional positive waves point away from ALS or motor neuron disease (MND)? In those cases, would the recruitment be reduced? The interpretation was mild S1 radiculopathy.
Hi,
Welcome to icliniq.com. I read your query and understand your concerns. First of all, I would like to inform you that the available EMG (electromyography) report does not suggest anything found in motor neuron disease (attachment removed to protect the patient's identity). My observation is based on the following facts: 1. There are no fasciculations. This (fasciculations) is a common observation during EMG and clinical presentation, as it is a sign of leftover neurons. 2. Good recruitment: Yes, you are correct that there is limited recruitment in MND (motor neuron disease) because few neurons are left, and they fail to activate additional motor units. Good recruitment is observed among healthy neuromuscular units to accomplish the task adequately. I hope this answers you.
Patient's Query
Hi doctor,
I received the MRI (magnetic resonance imaging) report and read it twice L5-S1. 1. The disc is subtly desiccated with bulge and annular fissure. 2. No central or foraminal stenosis was seen. 3. Minimal spurring towards the foramina. 4. No evidence of impingement upon the L5 nerve roots 1. 5. Disc bulges at the L4-L5 and L5-S1 with annular fissure but no significant neural compressive effect. 6. No evidence of frank disc herniation was seen. 7. No abnormal enhancing lesion was identified. 8. No evidence of abnormal nerve root enhancement. How likely is it that an magnetic resonance imaging (MRI) would miss mild S1 radiculopathy? Is it now more likely that I have amyotrophic lateral sclerosis (ALS)?
Hi,
Welcome back to icliniq.com. In the MRI (magnetic resonance imaging) report (attachment removed to protect the patient's identity), there is more evidence in favor of ALS (amyotrophic lateral sclerosis). The presence of backache, evidence for S1 radiculopathy, desiccated bulge, and annular fissure all indicate the same pathology. There is no neural compression, but the damage to the disc and herniated disc is enough to cause radiculopathy and fasciculations in your calf muscles. I do not think the magnetic resonance imaging (MRI) report missed the S1 radiculopathy as it could determine the probable cause for S1 radiculopathy. The current MRI report is helping you to understand the reasons for your present symptoms, and if there are no more symptoms other than those known to me, I think ALS is ruled out. I hope this answers you.
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Geriatrics
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