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Case Reports in Medicine
Volume 2012 (2012), Article ID 324685, 4 pages
http://dx.doi.org/10.1155/2012/324685
Case Report

Amyotrophic Lateral Sclerosis and Multiple Sclerosis Overlap: A Case Report

1Department of Neurology, Second University of Naples, 80138 Naples, Italy
2Magnetic Resonance Imaging Research Center SUN-FISM, Neurological Institute for Diagnosis and Care “Hermitage Capodimonte”, 80131 Naples, Italy

Received 12 September 2012; Revised 17 November 2012; Accepted 9 December 2012

Academic Editor: Mamede de Carvalho

Copyright © 2012 Francesca Trojsi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The concurrence of amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) is extremely rare. We reported the case of a 33-year-old woman with a past history of paresthesias at the right hand, who developed progressive quadriparesis with muscular atrophy of limbs and, finally, bulbar signs and dyspnea. Clinical and neurophysiologic investigations revealed upper and lower motor neuron signs in the bulbar region and extremities, suggesting the diagnosis of ALS. Moreover, magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis demonstrated 3 periventricular and juxtacortical lesions, hyperintense in T2 and FLAIR sequences, and 3 liquoral immunoglobulin G (IgG) oligoclonal bands, consistent with diagnosis of primary progressive MS (PPMS). This unusual overlap of ALS and MS leads to the discussion of a hypothetical common pathological process of immunological dysfunction in these two disorders, although the role of immune response in ALS remains ambivalent and unclear.