Question

Step # 1

Emmerson is an active 55-year old male of Asian descent who works as a nurse. About six months ago, his wife commented that he was dropping things and stumbling more commonly when he walked. Within the last few weeks, he has found it hard to work with patients due to weakness in his arms and legs.

What system(s) of the body could Emmerson be experiencing problems with and what diseases or disorders could be responsible for this?

Step # 2

A little more background on Emmerson. Up to this point in his life, he has been active and relatively healthy.  His work as a nurse keeps him active and in his spare time, he enjoys bicycle riding. He is 5'11" and 205 pounds and is a non-smoker.   Recent medical issues include a broken right radius as a result of a bicycle riding accident and the removal of a basal cell carcinoma from his forehead.

As the symptoms progressed, Emmerson visited his health care provider and the physician assistant he works with conducted the following tests:

- heart rate and blood pressure normal
- temperature normal
- mental status check - normal
- arm / hand strength - less than expected
- CBC (Complete blood count which looks at the numbers of blood cells) normal
- Blood chemistry panel - slightly elevated cholesterol, otherwise normal
- Suspecting muscular or neurological issues, the PA ordered an MRI and CT of the brain which were normal.

What types of tests should be done next?

Step #3

You all did a nice job of speculating on the cause, but we cannot reach a diagnosis without further tests. As a result, Emmerson was sent to a neurologist for further testing.  

Electromyogram - normal
Nerve Conduction test - mostly normal
Advanced blood tests - normal
Bone density test - normal
Microscopic examination of muscle tissue (biopsy) - normal

These results were surprising, so the neurologist asked for a more thorough background on Emmerson. At that time, Emmerson remembered a family story about an uncle he never met who died in his early 50's. When Emmerson called to relatives living in the Philippines, they told him that they thought his uncle died from Amyotrophic lateral sclerosis (ALS). What is ALS and could this be what Emmerson is experiencing?

**** I need help on step 3 I have answered step 1 and 2 already but find myself stumped now! thank you!!!

Answer 1

Amyotrophic lateral sclerosis (ALS) is rare and , is a progressive nervous system disease that affects nerve cells in the brain and spinal cord, causing loss of muscle control, in this disease most affected are the neurons which control voluntary functions, ALS often begins with muscle twitching and weakness in a limb, or slurred speech. Eventually, ALS affects control of the muscles needed to move, speak, eat and breathe.. In later stages of the disorder, aspiration pneumonia can develop which can be fatal, Most people with ALS die between two and five years after the diagnosis

Symptoms of stumbling more commonly when walking, droping things, weakness in arms and legs ,are all classic symptoms of ALS disease There are no test that can provide a definite diagnosis of ALS, thats the reason why all his tests were normal, instead of diagnosis, ALS is primarily based on the symptoms and signs the physician observes in the person and a series of tests to rule out other diseases. Physicians obtain the person's full medical history and usually conduct a neurologic examination at regular intervals to assess if the symptoms on muscle weakness is increasing or decreasing.

From all the evidence it more likely that this person is sufering from ALS.