Hey guys, as many of you know I have been posting audio recordings of my speech due to perceived slurred speech issues, I recently was cleared by a neurologist but unfortunately still experiencing symptoms. Can anyone tell any difference in my speech with this latest voice recording or does it sound the same as before?
Hi guys, as some of you know my story from my posts I just recently had a neuro appointment roughly 7 months after my perceived bulbar symptoms. Although it was all clear and he told me straight up I don’t have als, I’m still suffering from bulbar symptoms. Constant throat and tongue tightness that feels like a strain on my voice. Continued effortfull speech and vocal tiredness. I notice it more when I sing. honestly don’t know what to do. I haven’t ever been suicidal but with these symptoms not stopping and continuing to get worse I don’t know when this suffering will end. I try my best to distract my self by going outside and telling my self it’s anxiety, but after a while I’m beginning to stop believing my self.
Hey folks, this is my neuro report of my perceived bulbar symptoms (slurred speech and tongue weakness). If you guys could tell me where to go from here as I’m still experiencing symptoms although I’ve been told that thier is no evidence of mnd. By this time can I be reassured this isn’t anything serious? My only worry was the increase of my nfl from 5.04 to 7.7 in 5 months but my neuro has said this is just a fluctuation and combined with my EMG report that I have nothing to worry about. I’d appreciate any advice thanks.
(Reason for Visit)
Thank you for referring Moe a 29-year-old right-handed gentleman, for evaluation of dysarthria.
Electromyography was performed today.
(History of Present Illness)
Moe is a 29-year-old patient who presents with constant perceived slurred speech and tongue symptoms beginning in October. The patient describes the speech as effortful and no longer automatic, feeling stretched. The tongue feels constantly weak and tense, and now rests at the bottom of the mouth instead of at the roof of the mouth. The patient notes that when speaking in long sentences, there is a tendency to mumble toward the end of sentences. There is constant tongue awareness that the patient finds distressing. The patient has a lifelong stutter dating from childhood, which is a separate issue from the current concerns. The patient took 0.5mg of clonazepam prior to this appointment for anxiety. Previous evaluations include an ENT assessment in December which showed nothing abnormal in the back of the throat, and an evaluation by Dr. Charles Krieger in January who found no tongue weakness on examination but the patient requested a bulbar EMG for reassurance to rule out any neurogenic cause. He has also had investigations by Dr. Jack in 2024/2025 with normal electrophysiology. The patient experiences jaw jerks frequently and chin twitches that come and go. There is no trouble with vision optosis, and no facial weakness other than the tongue symptoms. The patient specifically expressed concern about bulbar onset ALS given the age of 29 years. He denies appendicular weakness or fatigability, sensory loss, or balance difficulties. There are no bowel or bladder changes.
(Physical Exam)
Cranial nerve examination was normal. He has no obvious stutter but no dysarthria or dysphonia. Normal tongue strength and no atrophy/fasciculations.
On motor examination he has normal tone, bulk, power throughout. Reflexes are 2+ and symmetric. Plantar responses were flexor.
(Electrophysiologic Studies)
SENSORY: Not performed
MOTOR: Not performed
EMG: Right genioglossus, trapezius, deltoid, and first dorsal interosseous (FDI) were all normal without evidence of denervation or reinnervation changes.
IMPRESSION: Normal studies. There is no electrophysiological evidence for a myopathy, bulbar mononeuropa or anterior horn cell disease.
(Problem List/Past Medical History)
(Medications)
(Allergies)
Sulfacetamide Sodium
sulfa drugs
(Imaging Investigation)
Normal MRI brain and cervical spine from a year and half ago.
(Assessment plan)
This 29-year-old patient presents with subjective tongue weakness and speech changes since October, distinct from a lifelong stutter. The neurological examination today showed normal cranial nerve function including normal tongue strength. Electromyography is normal. There was no evidence for an anterior horn cell disorder, myopathy, or compression mononeuropathy affecting the tongue. Furthermore, EMG of the right upper limb shows no evidence for the same. Hopefully has able to reassure him he does not have ALS, I do not have a neuromuscular answer as to why his tongue feels abnormal. He appropriately has had an MRI of the brain previously which was normal a year and a half ago and his exam is reassuringly normal. Hopefully this information is some help to you. Follow-up has not been arranged.
The right underneath side looks thinner and is more indented then the left. Is this normal or atrophy?
My wrist in my right hand has been constantly twitching for the past 2 days. Has this happened to anyone?
Has anyone had constant wrist twitches? My right wrist hasn’t stopped twitching for almost 2 days. Very annoying.