Would ALS with bulbar onset (initially affecting speech, chewing and swallowing) also show Babinskis sign?
LS: Yes. Generally people have both bulbar and corticospinal damage together, though the symptoms may not show up together. What else do you look for in the physical exam? LS: The distribution of weakness. For example, in Charcot-Marie-Tooth disease Type 1A, weakness and wasting arefound most prominently in the distal muscles, those farthest from the trunk, while in SMA, the weakness is more proximal (near the center of the body). Distribution is also important for distinguishing among the muscular dystrophies. The name “facioscapulohumeral” muscular dystrophy states the distribution of the primary weakness: in the facial muscles, the scapular muscles of the back and the proximal arm muscles, surrounding the humerus (the long bone of the upper arm). What is the role of lab testing in diagnosis? LS: In certain cases, the history and the physical exam cantake you to a point, and then you need to differentiate. If it’s clear from the exam that you are dealing with a primary muscle disease
