A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height.
- If tapping the muscles or cold stimuli can induce fasciculations (involuntary movements of very small muscle groups), further diagnostic steps must be taken.
- Neurological examination – including strength testing, triggering reflexes, etc. [due todifferential diagnoses:
- Chronic inflammatory demyelinating polyneuropathy (CIDP) – attenuation of muscle reflexes, protein elevation in cerebrospinal fluid (“nerve water“), pathologic nerve conduction velocity.
- Neuropathy (multifocal, motor).
- Polyneuropathy (chronic, motor)
- Pseudobulbar paralysis – disease caused by a lesion of the tractus corticobulbaris (corticonuclearis); clinical picture: dysarthria (speech disorders), tongue mobility impairments, dysphagia (dysphagia) and hoarseness, furthermore (apparent) affect incontinence (lack of affect control) with forced laughter and forced crying.
- Syringobulbia – disease of the medulla oblongata associated with its destruction.
- Syringomyelia – neurological disease that usually begins in middle age and leads to the formation of cavities in the gray matter of the spinal cord.
- Cervical myelopathy (chronic) – disease affecting the cervical portion of the spinal cord, occurring primarily in spinal stenosis]
- ENT examination (in case of exclusively bulbar and pseudobulbar manifestation] [due todifferential diagnosis:
- Speech and swallowing disorders]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
Diagnostic criteria of ALS
- For the diagnosis of amyotrophic lateral sclerosis, the presence of clinical pathology of the 1st and 2nd motor neuron at one level (bulbar, cervical, thoracic, lumbosacral) is required; alternatively, for the 2nd motor neuron, electrophysiological signs of damage (EMG) at two levels.
- The presence of nonmotor symptoms (e.g., dementia) is consistent with a diagnosis of ALS. So is the presence of sensory and oculomotor symptoms.
