Amyotrophic lateral sclerosis physical examination

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Physical Examination

Pulmonary

• Nocturnal hypoventilation
• Pneumonia may compromise pulmonary function even further
• Pulmonary failure
• Pulmonary function test:
  • Decreased forced vital capacity
  • Inspiratory pressure diminishes

Gastrointestinal

• Constipation

Neurologic

• Limb onset:
  • Awkwardness when walking or running
  • Tripping or stumbling
  • Difficulty with simple tasks requiring manual dexterity such as buttoning a shirt, writing, or turning a key in a lock** Occasionally the symptoms remain confined to one limb; this is known as monomelic amyotrophy.
• Bulbar onset:
  • These patients first notice difficulty speaking clearly
  • Garbled and slurred speech
  • Nasality and loss of volume are frequently the first symptoms
  • Difficulty swallowing and loss of tongue mobility follow
  • Eventually total loss of speech and the inability to protect the airway when swallowing are experienced
• Muscle weakness and atrophy spread to other parts of the body as the disease progresses
• Increasing difficulty moving
• Swallowing (dysphagia)
• Speaking or forming words (dysarthria)
• Upper motor neuron involvement:
  • Spasticity
  • Hyperreflexia or exaggerated reflexes including overactive gag reflex and positive Babinski sign
• Lower Motor Neuron involvement:
  • muscle weakness and atrophy,
  • muscle cramps, and
  • fleeting twitches of muscles that can be seen under the skin (fasciculations)
• 45% of patients experience pseudobulbar affect, also known as "emotional lability" attributable to degeneration of bulbar upper motor neurons resulting in exaggeration of motor expressions of emotion
  • uncontrollable laughter
  • crying or smiling
• Frontotemporal dementia