Amyotrophic lateral sclerosis with multiple sclerosis: A clinical and pathological report

We report a 62-year-old woman with a past history of painful central visual loss who developed progressive quadriparesis and bulbar palsy, Neurologica l examination revealed widespread upper and lower motor neuron signs in the bulbar region and extremities. Electromyography demonstrated widespread ac tive and chronic motor axon loss. Magnetic resonance neuroimaging studies r evealed enhancing callosal and periventricular white matter lesions and cer vical and thoracic cord hyperintensities. Cerebrospinal fluid analysis was consistent with multiple sclerosis. The patient died of respiratory failure two years after presentation, and autopsy revealed multifocal demyelinatio n involving the corpus callosum, cerebellum and spinal cord as well as path ologic findings typical of amyotrophic lateral sclerosis. A review of the l iterature confirms the exceedingly unusual combination of amyotrophic later al sclerosis with multiple sclerosis.