Presentation
Progressive weakness.
Patient Data
Hyperintensity on T2, FLAIR 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 "hypointensity in the precentral gyrus, known as the motor band sign" on the eSWAN sequence.
Small vessel ischemic change of the white matter.
Case Discussion
The MRI features support the clinical and EMG of upper and lower motor neuron degeneration.
Amyotrophic lateral sclerosis (ALS), is 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, known as the "motor band sign" is seen in ~50%.
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