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Amyotrophic lateral sclerosis

Case contributed by Ammar Haouimi
Diagnosis almost certain


Progressive weakness in a hypertensive patient.

Patient Data

Age: 60 years
Gender: Female

Hyperintensity on FLAIR/T2 and DWI of the cortex of the precentral gyri descending along the corticospinal tracts in the posterior aspect of internal capsules and brainstem.

No visualization of the "motor band sign" on eSWAN sequence.

 White matter T2 hyperintense lesions (chronic small vessel ischemia).

Case Discussion

Amyotrophic lateral sclerosis (ALS),  is considered as the most common form of motor neuron disease characterized by progressive weakness and eventual death due to respiratory insufficiency.

On MRI it is characterized by a hyperintensity on T2-weighted imaging along the corticospinal tracts. The loss of signal on GRE and SWI of the precentral gyrus is seen in ~50%.

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