Respiratory failure in a patient with antecedent poliomyelitis: amyotrophic lateral sclerosis or post-polio syndrome?
We report a 69-year-old man who developed paralytic poliomyelitis in childhood and then decades later suffered from fatal respiratory failure. Six months before this event, he had progressive weight loss and shortness of breath. He had severe muscular atrophy of the entire right leg as a sequela of the paralytic poliomyelitis. He showed mild weakness of the facial muscle and tongue, dysarthria, and severe muscle atrophy from the neck to proximal upper extremities and trunk, but no obvious pyramidal signs. Electromyogram revealed neurogenic changes in the right leg, and in the paraspinal, sternocleidomastoid, and lingual muscles. There was a slight increase in central motor conduction time from the motor cortex to the lumbar anterior horn. Pulmonary function showed restrictive ventilation dysfunction, which was the eventual cause of death. Some neuropathological features were suggestive of amyotrophic lateral sclerosis (ALS), namely Bunina bodies. In patients with a history of paralytic poliomyelitis who present after a long stable period with advanced fatal respiratory failure, one may consider not only respiratory impairment from post-polio syndrome but also the onset of ALS.
Terao
Shin-ichi
S
Division of General Medicine, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi 480-1195, Japan. terao123@quartz.ocn.ne.jp
Miura
Naofumi
N
Noda
Aiji
A
Yoshida
Mari
M
Hashizume
Yoshio
Y
Ikeda
Hiroshi
H
Sobue
Gen
G
D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D018450:Disease Progression; D004569:Electroencephalography; D017809:Fatal Outcome; D006801:Humans; D002479:Inclusion Bodies / Q000473:pathology; D008297:Male; D009046:Motor Neurons / Q000473:pathology; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D009133:Muscular Atrophy / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology; D016262:Postpoliomyelitis Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D011712:Pyramidal Tracts / Q000473:pathology / Q000503:physiopathology; D012132:Respiratory Muscles / Q000294:innervation / Q000473:pathology / Q000503:physiopathology; D012133:Respiratory Paralysis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed