1. Amyotrophic Lateral Sclerosis (ALS)
A simple approach; an intuitive presentation
José Mª García Santos, MD, PhD.
Servicio de Radiología. Hospital Morales Meseguer. Murcia

2. Normal ALS Charcot, 1874 Spinal cord atrophy Muscular cord atrophy
Muscular cord atrophy

3. Piramidal tract degeneration (in the adult)
Secondary degeneration
Primary degeneration
Wallerian degeneration
Motor neuron disease
Amyotrophic Lateral Sclerosis
(lower and upper motor neuron disease)
When a nerve fiber is cut or crushed, in which the part of the axon separated from the neuron's cell body degenerates
Primary Lateral Sclerosis
(only upper motor neuron disease)
Progressive Spinal Atrophy
(only lower motor neuron disease)

4. Normal condition

5. Upper motor neuron
Lower motor neuron
Disease

6. Disease

7. Lateral sclerosis
Disease

8. Muscular atrophy
(denervation)
Lateral sclerosis
Disease

9. The usual spinal cord onset

10. Spinal cord onset Lower motor neuron Muscular atrophy Fasciculations
(denervation)
Fasciculations
Weakness
Spinal cord onset
Lower motor neuron

11. Hyperreflexia
Spinal cord onset
Upper motor neuron

12. Spinal cord onset Upper motor neuron Babinsky Hoffman Clonus
Hyperreflexia
Spinal cord onset
Upper motor neuron

13. Distal to proximal Spinal cord onset Fasciculations Weakness
Muscular atrophy
Distal to proximal
Spinal cord onset

14. Symmetry
Spinal cord onset

15. Later on
Dysarthria
Dysphagia
Dysphonia
Spinal cord onset

16. Other clinical presentations

17. Other clinical presentations
Proximal onset
Bulbar onset
Other clinical
presentations
Patchy onset

18. Other clinical presentations
Proximal onset
Bulbar onset
Other clinical
presentations
Patchy onset
Asymmetric onset

19. Differential diagnosis

21. Cervical Myelopathy …but also Miastenia gravis
Multiple Motor Neuropathy