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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31333
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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About a month ago I had an episode at work that appeared as

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About a month ago I had an episode at work that appeared as a small TIA. It started when I couldn't get my mouse on my computer to move correctly. After a few seconds I realized it wasnt my mouse but rather my right hand. Then I realized my right hand had gone numb. Several seconds later full feeling came back however my face felt odd. By the time I got over to someone my right side of my face under paralysis and my speech was slurred. again this only lasted a couple seconds. The whole episode was over in about five minutes followed my a slight headache and soreness on the right side of my face. I was realsed from the hospital told that it was anxiety/migraine. After the fact for weeks my right. Eye would twitch as well as my upper lip from time to time and i would have a slight pulling in my neck from time to time.Since then my legs have also been odd. The right one use to fall asleep very easily and as of the past month started to twitch a little under my knee...sometimes my left as well. It took me two months to get rid of the pain in my face as I was told by several doctors that I did or didn't have a sinus infection... after I woke up one morning with my face swollen on the right side near the maxillary sinus they labelled it a sinus infection. The antibotics seemed to have worked however im now wworried about my legs and worried what triggered the episode at work. At times I also have a pressure feeling in my arms like something is pushing against them.... that doesn't last long. I had a MRI. And CT and all came back clear. I have no problem believing this is anxiety but I just was to make sure it's nothing more serious like ALS. Thank you so much for your time.

Hello Valerie ,
I am Dr. Arun and will be helping you today.

ALS typically progresses within the area first affected and then to adjacent, contiguous regions. The symptoms do not regress or resolve usually. The diagnoses of ALS requires the following criteria;

1) Signs of lower motor neuron (LMN) degeneration by clinical (physical exam), electrophysiological (EMG and NCV) or neuropathologic examination,

2) Signs of upper motor neuron (UMN) degeneration by clinical examination, and

3) Progressive spread of signs within a region or to other regions, together with the absence of:
a) absence of other neurological diseases by the electrophysiological studies.
b) Neuroimaging (CT scan or MRI) evidence of other disease.

Thus your symptoms are unlikely to be ALS. Your symptoms are best explained by the migraine variants (atypical migraine), which have various neurological symptoms. Please read about the various wide presentation of the migraine variants in this authentic resource;

The other possibilities to consider for your symptoms would be:

1) Electrolyte derangement; unusual activity or unaccustomed activity 3-4 days ago before the episode may be responsible for it.

2) Increased caffeine or alcohol (if you do)

3) Medications or herbs (if you were on any).

4) Deficiency of vitamins.

You may consider following investigations (if not done earlier) just for the precautions;

1) electromyography (EMG)

2) nerve conduction velocity (NCV)

3) blood electrolytes like calcium, magnesium, potassium, sodium, etc

4) thyroid and parathyroid function tests

5) blood chemistry and complete metabolic profile.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.


I hope that this information is helpful. If you need further information, please just send me a reply asking for clarification. Once you are satisfied, I hope you will enter a positive rating so that I will be credited for assisting you. Thanks again for using this service. Your business is appreciated.

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Customer: replied 3 years ago.

thank you for your answer.I am happy to know that it doesn't sound like ALS. I had blood work done about a month ago. thyroid was normal. potassium and b12 was low and now taking supplements. the twitches and and leg issues subside when I walk...i also have shin splits like pain but i believe that would be due to the vitamin def. would that explain things?

You are very welcome, Valerie.

Deficiency of vitamin B 12 and potassium explain all the symptoms. Twitching is caused by minor muscle contractions in one particular area, or the persistent and uncontrolled twitching of a muscle group in a distribution of a single nerve fiber or filament. Usually they are benign and resolve on their own. B 12 deficiency is one of the common cause of persistent twitching. This is unlikely to be neurological in origin.

It is privilege assisting you.
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