Hi doctor, About five weeks ago, I started feeling some weakness in my left leg. I have consulted my family doctor and a neurologist. All physical tests showed no actual weakness. There were no other clinical signs and the reflexes were also normal. There is no activity or movement that I cannot do. When I run, I feel normal. The sensation has persisted and is difficult to describe. Sometimes it feels like weakness, but sometimes like an ache down my leg, particularly when I sit down for a longer period of time and then I feel sore on my lower left back, just above by buttocks. Overall, if I had to describe the sensation in my left leg, I will describe it as a sense of weakness. Apart from the persisting feeling of weakness, I have also noticed muscle twitches all over my body, including my left foot and primarily in both my legs. I know I have been aware of these for years, but I have been more aware of them lately. Every morning for the past three to four weeks, my left foot feels tight, a slight pain when I am walking. But, it does not persist all day and if I do not think about it, then it feels normal. If I do think about it, then it feels as if I am going to have foot drop, although it does not actually happen. On top of this, I frequently feel a sense of vibration at the bottom of my left foot particularly when lying or sitting down. It is hard to tell whether this is a spasm or numbness or tingling. In the past two weeks, I have had two periods of probably two to three days where I have felt cramped and tightness in my left leg particularly at the top of my left calf. I have had a brain MRI, which came back as normal. I have had a left knee ultrasound performed which shows a varicose small saphenous vein and my family doctor does not believe this explains my symptoms. Furthermore, I have had a lumbar CT which returned the following results. At L5-S1 moderate broad left paracentral disc protrusion mildly distorting the anterior aspect of the thecal sac and abutting without displacing the traversing nerve roots. Minor disc extension into the foramen at this level without exiting L5 nerve root impingement. Minor changes in the other levels also as described. However, again, my family doctor does not believe this is the cause of my symptoms. He maintains it is most likely from anxiety. I am a 21 year old medical student and to be completely honest, I made the mistake of initially looking up my symptoms online. I have been very anxious since I started experiencing the sense of weakness, as I am worried about the possibility of having ALS. I have constantly been stretching my legs and trying to test my left leg as a result. What is your recommendation? Also, could you please include what you think of the possibility of ALS, as this is my biggest concern at the moment. Thank you so much for your time.
Hi. The various symptoms you have described are due to L5-S1 moderate broad left paracentral disc protrusion mildly distorted the anterior aspect of the thecal sac and abutting without displacing the traversing nerve roots. When a disc prolapses and compresses the spinal cord in cervical and thoracic levels, we get myelopathy. When it compresses the root, we get radiculopathy. But, please note that even when a prolapsed disc does not directly compress the spinal cord or nerve root, it can still produce symptoms if it compresses the blood vessels and interferes with blood flow. As a rule, veins are more easily compressed than arteries and the epidural plexus of veins are compressed by the prolapsed disc. This leads to venous stasis and the metabolites are not washed away from the nerve roots. However, this compression is dependant on the posture. When you move a bit, the pressure gets released and the blood flow resumes and the metabolites are washed and the nerve becomes functionally normal. So, even though you may be having symptoms at one time or another, the moment you walk to your doctor's room and climb the examination couch, all metabolites are washed away and your examination does not find any abnormality. However, the good news is that this condition can be treated by very simple postural adjustments as follows. For further information consult a neurologist online -->