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Letter
Persistent bitter taste as an initial symptom of amyotrophic lateral sclerosis
  1. G C Petzold,
  2. K M Einhäupl,
  3. J M Valdueza
  1. Department of Neurology, Charité Hospital, Humboldt University, Schumannstr 20/21, 10098 Berlin, Germany
  1. Correspondence to:
 Dr Petzold; 
 gabor.petzold{at}charite.de

https://doi.org/10.1136/jnnp.74.5.687-a

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    Amyotrophic lateral sclerosis (ALS) is characterised by progressive degeneration of upper and lower motor neurones. Clinical symptoms involve weakness, dysphagia, dysarthria, muscle atrophy and fasciculations, hyperreflexia, spasticity, Babinski signs, and clonus. Here we report on two patients with sporadic ALS in whom the disease initially presented with a persistent bitter “metallic” taste.

    Case reports

    Patient 1 was a previously healthy 60 year old women. Six months before admission, she noticed a persistent bitter taste, dysarthria, and emotional liability. Several weeks later she noticed a progressive weakness in both legs which spread to both arms within four months. At the time of admission, she had bilateral bulbar weakness, episodes of pathological crying, generalised spasticity, muscle atrophy, weakness, and fasciculations. The plantar reflex was extensor on the left side. The remaining neurological examination was unremarkable.

    Patient 2 was a previously healthy 64 year old women. At the time of admission, she reported a four month history of a persistent bitter “metallic” taste confined to the posterior tongue, …

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    Footnotes

    • Competing interests: none declared