Sporadic amyotrophic lateral sclerosis. A clinical analysis

Objective. To illustrate that sporadic amyotrophic lateral sclerosis (ALS) may be caused by ischemia in the intraparenchymal territory of the anterior spinal artery (ASA) and/or anterior-ventral spinal arteries (AVSAs). Case report. A 56-year-old woman presented clinical data of spinal and bulbar forms of ALS. Previously she was attended in several neurological centers. Results. In 2002 the patient began with paresthesias of the fingers in both hands. Three years later, she presented fasciculations in her left hand and later on, in the right hand, ascending to the forearm, arm and shoulder girdle muscles. Since October 2008, she presented fasciculations in thighs and legs, and finally, bulbar symptoms. The examination revealed dysarthria, weak voice, fasciculations and paresis in the tongue. Spastic tetraparesis and muscular atrophy, predominantly in the upper limbs. The superficial and deep sensory signs were normal. Conclusions. The onset and clinical course of the symptoms in this patient, it suggests that sporadic ALS is of ischemic origin in the intraparenchymal territory of the ASA and/or AVSAs, secondary to vascular anomalies and atherosclerosis.