A 60-year-old man presented with progressive weakness for 2 years that began in the right arm and subsequently spread to all limbs. On examination, he had both upper and lower motor neuron signs including spasticity, hyperreflexia, and fasciculations in addition to asymmetric weakness. The sensory examination was normal. He was diagnosed with amyotrophic lateral sclerosis (ALS). MRI showed bilateral symmetric hyperintensities on fluid-attenuated inversion recovery sequence, corresponding to the degeneration of the corticospinal tracts from the level of motor cortex to ventral pons as shown in the figure. From 22 to 39% of patients with ALS will have this finding on brain MRI.1,2
Figure Axial MRI of the brain with fluid-attenuated inversion recovery sequence revealing symmetric hyperintensities in precentral gyri (A), corona radiata (B), posterior limbs of the internal capsules (C), cerebral peduncles in the midbrain (D), and ventral pons (E) corresponding to the degeneration of the corticospinal tracts
Footnotes
-
Disclosure: The authors report no disclosures.
Disputes & Debates: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.