Jose G. Lima, BS
Medical Student
FIU HWCOM
Miami Gardens, Florida, United States
Mikahla E. Gay, BA
Medical Student
FIU HWCOM
Doral, Florida, United States
Richard C. Morgan, DO
Physician
Miami Neuroscience Institute
Miami, Florida, United States
Amyotrophic Lateral Sclerosis
Case Description:
A 56-year-old right-hand dominant female writer presented to the PM&R clinic with neck pain, bilateral numbness in the distal upper extremities, and left-sided muscle wasting. Her symptoms began six months prior, and she was followed by pain management for predominant symptoms of neck pain with radiculopathy. An EMG ruled out Carpal Tunnel Syndrome and she was referred to neurosurgery for cervical radiculopathy. Upon neurosurgical evaluation, the patient described glove-pattern numbness in the left hand extending to the elbow. Findings were inconsistent with cervical radiculopathy, and she was referred for a repeat EMG. During physiatry evaluation, motor strength testing revealed decreased grip strength bilaterally, decreased finger abduction and adduction bilaterally, and decreased left wrist extension and flexion. Hyperreflexia was noted in the brachioradialis, triceps, patella, and Achilles bilaterally, along with tongue fasciculations and upgoing Babinski bilaterally. EMG testing revealed active denervation and reinnervation in the left upper extremity.
Discussions:
Amyotrophic Lateral Sclerosis (ALS) is a motor neuron disease characterized by upper and lower motor neuron symptoms, with a prevalence of 6.6 per 100,000 people. Early ALS symptoms can mimic other conditions, such as cervical spondylitis myelopathy and spinal cysts, complicating diagnosis. In this case, the patient’s first symptom was hand muscle atrophy, and it took several months to diagnose ALS due to other potential differentials. This highlights the importance of considering ALS in patients with muscle wasting. Comprehensive musculoskeletal and neurological exams are essential in patients with suspected radiculopathy or neuronal disease, and EMG testing can be a valuable tool in confirming an ALS diagnosis.
Conclusions:
This case underscores the diagnostic challenges of ALS due to its varied presentations and the numerous conditions that mimic it. Our study emphasizes the importance of recognizing early signs, such as muscle atrophy, and considering ALS as a differential diagnosis in these patients.
