The diagnosis of amyotrophic lateral sclerosis is usually one of the easiest to make, characterized as the syndrome is by involvement of the anterior horn or nuclear cell groups, that is, lower motor neuron, and the pyramidal tract, or upper motor neuron. Generally, the atrophy begins in the hands and, after a variable period, the degenerative process ascends and involves the bulbar motor nuclei. At some time in the course of the disease, signs of involvement of the pyramidal tract appear. The latter are most evident in the lower extremities, though the hyperreflexia also points to their presence in the region of the atrophies. Most often, involvement of the anterior horn precedes and dominates the picture. Rarely, the pyramidal tract signs appear first and those referable to the lower motor neurons play a secondary rôle. Sensory disturbances, however, either are absent or occur rarely. While subjective disturbances, such as mild
WECHSLER IS, BROCK S, WEIL A. AMYOTROPHIC LATERAL SCLEROSIS WITH OBJECTIVE AND SUBJECTIVE (NEURITIC) SENSORY DISTURBANCES: A CLINICAL AND PATHOLOGIC REPORT. Arch NeurPsych. 1929;21(2):299–310. doi:10.1001/archneurpsyc.1929.02210200055006
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