History: A 70-year-old male patient was admitted to the neurology clinic with progressive muscle weakness for the last 6 months. He had no known disease and his anamnesis was unremarkable. There was no patient with similar complaints in his family history.
Physical examination: Physical examination revealed muscle atrophy, decreased muscle tone, and hyperreflexia.
Laboratorary and imaging finding: There was no significant finding in laboratory findings. In the EMG, there were findings suggesting the involvement of anterior horn cells. In the brain MRI, the images were as follows.
MRI:
It's T2/FLAIR image. We see hyperintensity in corticospinal tract.
It is susceptibility weighted image(SWI). This sequence is sensitive to magnetic substances such as iron. Blood products are seen hypointense in this method. In this image, hypointensity in the bilateral precentral gyrus suggests iron accumulation in this region.. This motor is called the band sign. However, it should not be forgotten that this finding can also be seen in neurodegenerative diseases such as Parkinson's disease.
Discussion-Pearls:
Anterior horn involvement can be seen in diseases such as poliomyelitis, spinal muscular atrophy, amyotrophic lateral sclerosis and progressive muscular atrophy.
On MRI images, there was a decrease in signal on SWI images in bilateral precentral gyrus and an increase in FLAIR signal on bilateral corticospinal tract. Considering all these findings together, it was evaluated as amyotrophic lateral sclerosis.
Physical examination: Physical examination revealed muscle atrophy, decreased muscle tone, and hyperreflexia.
Laboratorary and imaging finding: There was no significant finding in laboratory findings. In the EMG, there were findings suggesting the involvement of anterior horn cells. In the brain MRI, the images were as follows.
MRI:
It's T2/FLAIR image. We see hyperintensity in corticospinal tract.
It is susceptibility weighted image(SWI). This sequence is sensitive to magnetic substances such as iron. Blood products are seen hypointense in this method. In this image, hypointensity in the bilateral precentral gyrus suggests iron accumulation in this region.. This motor is called the band sign. However, it should not be forgotten that this finding can also be seen in neurodegenerative diseases such as Parkinson's disease.
Discussion-Pearls:
Anterior horn involvement can be seen in diseases such as poliomyelitis, spinal muscular atrophy, amyotrophic lateral sclerosis and progressive muscular atrophy.
On MRI images, there was a decrease in signal on SWI images in bilateral precentral gyrus and an increase in FLAIR signal on bilateral corticospinal tract. Considering all these findings together, it was evaluated as amyotrophic lateral sclerosis.
