title: Atypical presentations of spinal muscular atrophy type III (Kugelberg-Welander disease).
abstract: Spinal muscular atrophy type III (SMA III, Kugelberg-Welander disease) typically presents with symmetric proximal weakness, areflexia, and hypotonia. We present four children with spinal muscular atrophy type III who had atypical phenotypes. Three patients clearly had asymmetric weakness at presentation and two had upper motor neuron signs in the lower extremities (one patient had both features). Two of the patients had prolonged evaluations before the diagnosis was made. All patients had Gowers signs and two had pes planus. In patients with proximal muscle weakness the presence of asymmetrical weakness, upper motor neuron signs, or both, may be compatible with spinal muscular atrophy type III. The diagnosis of spinal muscular atrophy should be considered when other possibilities have been excluded.
authors.affiliation: Department of Neurology, Children's Hospital Boston and Harvard Medical School, Fegan 11, 300 Longwood Avenue, Boston, MA 02115, USA.
authors.forename: P B
authors.initials: PB
authors.lastname: Kang
authors.forename: K S
authors.initials: KS
authors.lastname: Krishnamoorthy
authors.forename: R M
authors.initials: RM
authors.lastname: Jones
authors.forename: F D
authors.initials: FD
authors.lastname: Shapiro
authors.forename: B T
authors.initials: BT
authors.lastname: Darras
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005413:Flatfoot / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009046:Motor Neurons / Q000473:pathology*; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000294:innervation / Q000473:pathology / Q000503:physiopathology*; D009460:Neurologic Examination; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology; D014897:Spinal Muscular Atrophies of Childhood / Q000175:diagnosis / Q000503:physiopathology*