Reversible sub-acute motor neuron syndrome after mushroom intoxication masquerading as amyotrophic lateral sclerosis

Early-onset, conjugal, twin-discordant, and clusters of sporadic ALS: Pathway to discovery of etiology via lifetime exposome research

“…Testing that relationship requires a detailed understanding of the lifetime exposome prior to onset of motor symptoms, not the rather superficial knowledge of exposures gained through epidemiological surveys of ALS, which have tended to emphasize occupational exposures ( Holloway and Mitchell, 1986 ; Chancellor et al, 1993 ; Graham et al, 1997 ; GBD 2016 Motor Neuron Disease Collaborators, 2018 ) and have rarely examined dietary history. An example of studying individual subjects with uncommon forms of ALS is a 56-year-old man with a history of poisoning from eating either crude or undercooked false morels: he developed muscle cramps, nausea and vertigo, and a rapidly evolving/sub-acute upper and lower motor neuron syndrome with significant weakness in all four limbs and bulbar region; however, 6 months later, his condition plateaued, and he began a progressive recovery over subsequent years to reach normal neurological status with no electromyographic evidence of denervation ( Lagrange et al, 2021a ). Note that certain other Gyromitra spp.…”