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The neurological examination is a “head to toe” examination of your body. The examination will start with the neurologist assessing your clarity of mind. He or she will look for problems in memory, behavior, or mood to determine your “mental status”.
When the “mental status” part of the examination is complete, the next step is to exam the nerves innervating the head and neck. Some of the activities the neurologist will tell you to do might seem silly such as “puffing out your cheeks,” or “sticking out your tongue.” However as a trained professional, the neurologist will have a keen eye to notice when these actions are not performed correctly. This can indicate the various nerves affected by ALS.
After the examination of the head and neck, the neurologist will proceed to exam your torso and extremities. He or she will look for weakness in the limbs or muscle tremors.
The last step within the neurological examination is to assess your reflexes. The neurologist will pay important attention to areas of your limbs showing decreased, increased, or absent reflexes.
Electromyography is concerned with testing nerve impulses, the nerves, and the muscles they innervate. It is mainly completed to test the function of lower motor neurons.
During the first part of the EMG, motor and sensory nerves are tested. This first part of the test will investigate whether nerve impulses are being conducted at a normal rate.
The second part of the EMG involves a needle used as an electrode placed inside the muscles on different areas of the body. The second part of the test will be used to determine which muscles are affected.
A MRI is another test the neurologist might order for you. A magnetic resonance imaging test will be able to detect any changes to soft tissues. For example, an MRI might be used to locate cancer of the brain or spinal cord, which might be causing your symptoms using magnetic technology.
The neurologist you are referred to you will spend time reading your medical file and reviewing any test results completed by your family doctor. Afterwards, he or she will ask you general questions related to the symptoms you are experiencing. From this discussion, the neurologist will ask more specific questions related to almost every area of your body. These questions can include, “Any problems with talking, eating, or swallowing?” or “Any changes in sight or memory loss?”
This might seem tiresome to you, but realize the neurologist is making sure that no symptom is overlooked which could point to a differential diagnosis. After the initial question and answer period, the neurologist will perform a neurological exam.
Blood tests for people suspected of having ALS are routine laboratory tests. Usually ALS patients will not show any abnormalities within their blood, but blood tests are conducted to show that no other disease is present that is being mistaken for ALS.
For example, a blood test will be able to check your blood cell count, hormone levels, as well as liver and kidney function to detect if any infections are present.
When you visit your doctor for a diagnosis, he or she will complete two tasks before arriving at an ALS diagnosis. The first task involves finding clues that are characteristics of ALS, and the second task involves trying to find clues that point to another disease. This second task is called the differential diagnosis. Looking for the differential diagnosis, especially in a disease that is fatal, is necessary to arrive at the correct diagnosis.
Some diseases that are a differential diagnosis for ALS, because they share similar symptoms include:
· Creutzfeldt-Jakob Disease
· Primary Lateral Sclerosis
· Kennedy's Disease
· Spinal Muscular Atrophy
· Lyme Disease
· Hereditary Spastic Paraplegia
· Spondylotic Myelopathy
Your doctor will carry out as many tests as possible to confirm or discard the diagnosis of ALS.
The first step in diagnosing ALS begins with a visit to your family doctor. It is important to consult your family doctor when you start to have any unexplained symptoms, especially symptoms of muscle weakness, stiffness, or fatigue.
Your family doctor will ask general questions, such as “When did you first notice the problems you are having?” or “Have you experienced this before?” It is important to answer truthfully, and your family doctor will next complete a physical exam of the areas you are having difficulties with.
The physical examination will provide more information than what you are able to tell your doctor. It will be similar to other physical exams in the past. For example, the family doctor will check routine things such as your blood pressure. Routine tests might be ordered as well and a referral is made to a neurologist. However, it is important as the symptoms worsen before you see the neurologist, to inform your family doctor.
After the neurological examination, there will be another set of tests. These laboratory tests are necessary to confirm a positive diagnosis, and rule out a differential diagnosis.
The laboratory tests to follow include blood tests, Cerebrospinal fluid (CSF) analysis, Magnetic Resonance Imaging, Electromyography, and other tests if you present with rare symptoms.
Another test you may not be familiar with, but might have to undergo is a Cerebrospinal fluid analysis. Cerebrospinal fluid is the liquid located surrounding the brain and spinal cord. The neurologist will carry out a lumbar puncture and use a needle to withdraw some of this fluid for analysis. He or she will investigate if the fluid is normal, by looking at components such as the number of cells present, or the level of protein and glucose inside the CSF.