title: Pseudopolyneuritic form of ALS revisited: clinical and pathological heterogeneity.
abstract: Pseudopolyneuritic form of ALS is a subtype of ALS characterized by distal weakness of the unilateral lower limb and absence of Achilles tendon reflex (ATR) at disease onset. Recognition of this form of ALS is important for clinicians because the combination of distal weakness of the lower limb and absence of ATR usually suggests peripheral neuropathy. We reviewed the clinical records of 42 autopsy-proven sporadic ALS cases and found three cases that showed onset of weakness of the unilateral lower limb with distal dominance and absence of ATR. The disease duration in the three cases was 2, 3 and 19 years, respectively. The clinical features of the patient with a course of 19 years had been restricted to lower motor neuron signs. Histopathologically, consistent findings in the three cases were severe motor neuron loss throughout the whole spinal cord, with relative preservation of the hypoglossal nucleus. Reflecting this finding, TDP-43-positive neuronal cytoplasmic inclusions in the spinal cord were sparse in two cases, and absent in a third. In the patient showing a clinical course of 19 years, mild corticospinal tract degeneration appeared to correspond to the absence of upper motor neuron signs and prolonged disease duration. In this case only, Bunina bodies were not demonstrated. In this study, we clarified the clinical and pathological heterogeneity of this form of ALS.
authors.affiliation: Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo. zen@bg7.so-net.ne.jp
authors.forename: Zen
authors.initials: Z
authors.lastname: Kobayashi
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Tetsuaki
authors.initials: T
authors.lastname: Arai
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokota
authors.forename: Sadakiyo
authors.initials: S
authors.lastname: Watabiki
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishizu
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Akiyama
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Mizusawa
mesh_terms: D000328:Adult; D000690:Amyotrophic Lateral Sclerosis / Q000473:pathology*; D004268:DNA-Binding Proteins / Q000096:biosynthesis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D002479:Inclusion Bodies / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology* / Q000503:physiopathology
chemical_list: D004268:DNA-Binding Proteins