"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead
Case report
peer-reviewed

Atypical Initial Presentation of Painful Muscle Cramps in a Patient with Amyotrophic Lateral Sclerosis: A Case Report and Brief Review of the Literature



Abstract

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized clinically by progressive muscle weakness that can occur proximally or distally in either the upper or lower extremities. It includes both upper motor neuron signs (spasticity, hyperreflexia, clonus, and Babinski sign) and lower motor neuron signs (atrophy, weakness, and muscle fasciculation). Initial presentation of progressively painful muscle cramps should lead the physician to screen for other signs of amyotrophic lateral sclerosis. We report the case of a 51-year-old male, who presented with dull muscle cramps in the right upper shoulder and arm. After a careful history and physical exam, it was found that patient had both upper and lower motor neuron signs; therefore, a diagnosis of amyotrophic lateral sclerosis was made. Amyotrophic lateral sclerosis should strongly be considered in the differential diagnosis of patients presenting with an atypical initial presentation of progressively painful muscle cramps.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Case report
peer-reviewed

Atypical Initial Presentation of Painful Muscle Cramps in a Patient with Amyotrophic Lateral Sclerosis: A Case Report and Brief Review of the Literature


Author Information

Aaron R. Kuzel

Department of Emergency Medicine, Lincoln Memorial University-Debusk College of Osteopathic Medicine

Muhammad Uzair Lodhi Corresponding Author

Internal Medicine, Raleigh General Hospital, Beckley, Wv

Intekhab Askari Syed

Internal Medicine, Beckley Appalachian Regional Healthcare

Family Medicine, Raleigh General Hospital, Beckley, Wv

Mustafa Rahim

Assistant Clinical Professor of Internal Medicine, West Virginia University School of Medicine

Adjunct Faculty, Lincoln Memorial University, School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Share
Case report
peer-reviewed

Atypical Initial Presentation of Painful Muscle Cramps in a Patient with Amyotrophic Lateral Sclerosis: A Case Report and Brief Review of the Literature

Aaron R. Kuzel">Aaron R. Kuzel, Muhammad Uzair Lodhi ">Muhammad Uzair Lodhi , Intekhab Askari Syed">Intekhab Askari Syed, Mustafa Rahim ">Mustafa Rahim

  • Author Information
    Aaron R. Kuzel

    Department of Emergency Medicine, Lincoln Memorial University-Debusk College of Osteopathic Medicine

    Muhammad Uzair Lodhi Corresponding Author

    Internal Medicine, Raleigh General Hospital, Beckley, Wv

    Intekhab Askari Syed

    Internal Medicine, Beckley Appalachian Regional Healthcare

    Family Medicine, Raleigh General Hospital, Beckley, Wv

    Mustafa Rahim

    Assistant Clinical Professor of Internal Medicine, West Virginia University School of Medicine

    Adjunct Faculty, Lincoln Memorial University, School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: November 10, 2017

    DOI

    10.7759/cureus.1837

    Cite this article as:

    Kuzel A R, Lodhi M, Syed I, et al. (November 10, 2017) Atypical Initial Presentation of Painful Muscle Cramps in a Patient with Amyotrophic Lateral Sclerosis: A Case Report and Brief Review of the Literature . Cureus 9(11): e1837. doi:10.7759/cureus.1837

    Publication history

    Received by Cureus: October 21, 2017
    Peer review began: November 07, 2017
    Peer review concluded: November 07, 2017
    Published: November 10, 2017

    Copyright

    © Copyright 2017
    Kuzel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized clinically by progressive muscle weakness that can occur proximally or distally in either the upper or lower extremities. It includes both upper motor neuron signs (spasticity, hyperreflexia, clonus, and Babinski sign) and lower motor neuron signs (atrophy, weakness, and muscle fasciculation). Initial presentation of progressively painful muscle cramps should lead the physician to screen for other signs of amyotrophic lateral sclerosis. We report the case of a 51-year-old male, who presented with dull muscle cramps in the right upper shoulder and arm. After a careful history and physical exam, it was found that patient had both upper and lower motor neuron signs; therefore, a diagnosis of amyotrophic lateral sclerosis was made. Amyotrophic lateral sclerosis should strongly be considered in the differential diagnosis of patients presenting with an atypical initial presentation of progressively painful muscle cramps.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Aaron R. Kuzel, Medical Student

Department of Emergency Medicine, Lincoln Memorial University-Debusk College of Osteopathic Medicine

Muhammad Uzair Lodhi , Medical Student

Internal Medicine, Raleigh General Hospital, Beckley, Wv

For correspondence:
lodhimu@mcmaster.ca

Intekhab Askari Syed, Medical Student

Internal Medicine, Beckley Appalachian Regional Healthcare

Mustafa Rahim , M.D.

Assistant Clinical Professor of Internal Medicine, West Virginia University School of Medicine

Aaron R. Kuzel, Medical Student

Department of Emergency Medicine, Lincoln Memorial University-Debusk College of Osteopathic Medicine

Muhammad Uzair Lodhi , Medical Student

Internal Medicine, Raleigh General Hospital, Beckley, Wv

For correspondence:
lodhimu@mcmaster.ca

Intekhab Askari Syed, Medical Student

Internal Medicine, Beckley Appalachian Regional Healthcare

Mustafa Rahim , M.D.

Assistant Clinical Professor of Internal Medicine, West Virginia University School of Medicine