MRI in amyotrophic lateral sclerosis: more than a promise

In amyotrophic lateral sclerosis, the deadliest form of motor neuron diseases, physicians observe the spread of non-painful paralysis with intact sensory function often presenting as asymmetric muscle atrophy and brisk or maintained reflexes. Using Awaji criteria to estimate upper and lower motor neuron signs in bulbar, cervical, thoracic and lumbar regions, and the highly sensitive electromyography (EMG), they diagnose amyotrophic lateral sclerosis (ALS) in a majority of the cases. The spread of symptoms is attributed to spinal motor neuron pathology, but experienced ALS neurologists will agree that a slowing of movement, loss of fine motor control and occurrence of mass or mirror movements indicate central motor pathway dysfunction, even in the absence of definite pyramidal signs. ALS naïve physicians may misinterpret these ‘soft signs’ of upper motor neuron dysfunction as stroke sequelae and not ALS related, and contribute to unnecessary delays in diagnosis. Unfortunately, we have no tool available...
Source: Journal of Neurology, Neurosurgery and Psychiatry - Category: Neurosurgery Authors: Tags: Dementia, Drugs: CNS (not psychiatric), Motor neurone disease, Neuromuscular disease, Spinal cord, Stroke, Memory disorders (psychiatry), Psychiatry of old age Editorial commentaries Source Type: research