Amyotrophic lateral sclerosis physical examination

Amyotrophic lateral sclerosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Amyotrophic lateral sclerosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Amyotrophic lateral sclerosis physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Amyotrophic lateral sclerosis physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Amyotrophic lateral sclerosis physical examination
CDC on Amyotrophic lateral sclerosis physical examination
Amyotrophic lateral sclerosis physical examination in the news
Blogs on Amyotrophic lateral sclerosis physical examination
Directions to Hospitals Treating Psoriasis
Risk calculators and risk factors for Amyotrophic lateral sclerosis physical examination

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