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Neurological picture
Misdiagnosis of amyotrophic lateral sclerosis in a patient with dysphagia due to Chiari I malformation
  1. M Paulig,
  2. M Prosiegel
  1. Neurologisches Krankenhaus, Tristanstrasse 20, D-80804 Munich, Germany
  1. Correspondence to:
    Dr M Paulig

https://doi.org/10.1136/jnnp.72.2.270

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    A 78 year old woman was admitted to our hospital`s swallowing department because she had had progressive dysphagia for a year. Based on bilateral tongue atrophy with fibrillations and a normal CT, amyotrophic lateral sclerosis with bulbar onset had been diagnosed 1 month previously and a percutaneous gastrostomy was performed for feeding purposes.

    The neurological examination on admission disclosed a dysphagia with signs of aspirations of saliva, extensive bilateral paresis, and atrophy of the tongue (fig 1 A) showing diffuse fibrillations. Further neurological examination was normal.

    Somatosensory evoked potentials and nerve conduction studies as well as …

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