Abstract Details

Title Recognizing Amyotrophic Lateral Sclerosis Early: Bilateral Internal Capsule Hyperintensities as a Diagnostic Clue

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 9-012

Objective N/A

Background Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting both upper and lower motor neurons, leading to muscle weakness, spasticity, and eventual respiratory failure. Although the diagnosis is primarily clinical-based on a combination of neurological examination and electromyographic findings, neuroimaging can support evaluation by excluding mimics and identifying subtle signs of corticospinal tract involvement. Bilateral internal capsule hyperintensities, though rare, may serve as an early radiologic clue in ALS.

Design/Methods N/A

Results A 57-year-old female presented with one year of progressive bilateral lower extremity weakness and fasciculations, which were noted in all extremities on examination. Additional findings included distal right upper limb atrophic spasticity, bilateral Hoffman signs, extensor plantar responses, brisk deep tendon reflexes throughout, and a spastic gait. Brain MRI revealed T2 hyperintensities in the bilateral posterior limbs of the internal capsule extending into the upper midbrain. The combination of upper and lower motor neuron signs, along with subtle bilateral corticospinal neuroradiological findings, raised concern for ALS, leading to appropriate management.

Conclusions

Symmetric internal capsule hyperintensities, while not commonly highlighted in ALS imaging, may indicate early corticospinal tracts involvement and serve as a subtle radiologic clue. While not definitive, these findings can raise clinical suspicion for ALS in patients with progressive motor symptoms. Early recognition of such imaging patterns, in conjunction with clinical signs, may facilitate timely diagnosis and intervention, ultimately improving care in neurodegenerative conditions like ALS.

Authors/Disclosures
Christopher Gilbert, MD (Trinity Health Grand Rapids) PRESENTER	Dr. Gilbert has nothing to disclose.
Taleen Shahrigian, DO (Trinity Health Grand Rapids)	Dr. Shahrigian has nothing to disclose.
Jason T. Schick, DO (Trinity Health Grand Rapids)	Dr. Schick has nothing to disclose.
Aileen Antonio, MD, FAAN (Trinity Health Grand Rapids Hauenstein Neurosciences)	Dr. Antonio has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cochrane. An immediate family member of Dr. Antonio has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Giamarco, Mullins & Horton PC. The institution of Dr. Antonio has received research support from Saint Mary's Foundation. Dr. Antonio has received research support from ��ɫ��. Dr. Antonio has received personal compensation in the range of $0-$499 for serving as a Invited Speaker with Michigan State University.
Christopher M. Goshgarian, MD	Dr. Goshgarian has nothing to disclose.
Melanie G. Taylor, MD	Dr. Taylor has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Argenx. Dr. Taylor has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen.
Joel N. Phillips, DO, FAAN (Trinity Health Physician Partners)	Dr. Phillips has nothing to disclose.

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