ALS Mimics due to Affection of the Cervical Spine: From Common Compressive Myelopathy to Rare CSF Epidural Collection

Abstract

Amyotrophic lateral sclerosis (ALS) is a clinically heterogeneous disease, with chameleon presentations and several mimics. Considering the poor prognosis of ALS, their precise and timely identification is pivotal. Affection of the cervical spine represents one potential source of ALS mimics that should never be missed, since it is potentially treatable. We hereby present 5 cases initially diagnosed as ALS but eventually found to have different kinds of cervical spine affection, from a common compressive myelopathy to a rare space-occupying cystic fluid collection.

Introductory Chapter: Motor Neurons – New Insights

“…Unfortunately, in cases of UMN-predominant ALS, particularly those with bulbar onset, its sensitivity is still unsatisfactory [33]. Brain and spinal cord magnetic resonance imaging is recommended in order to exclude structural lesions like infarct, cervical radiculomyelopathy, syrinx, demyelination, or neoplasm [34,35]. Moreover, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG) may reveal a typical pattern of perirolandic and prefrontal hypometabolism [36,37].…”

Decoding Amyotrophic Lateral Sclerosis: A Systems Biology Approach

“…65 Support for structural impediments in motor neuron disease includes recent MRI findings that have confirmed cervical spine abnormalities in patients with ALS and reduced CSF flow. 66 The glymphatic system refers to a network of venous perivascular spaces that directs interstitial fluid into the CSF. 67 The glymphatic system extends longitudinally down the entire length of the spinal canal through perivertebral veins that can become compressed due to neck trauma.…”