Amyotrophic lateral sclerosis physical examination
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Overview
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
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