Case 10 History ---- The patient was a 56 year old male with ALS who became symptomatic in the summer of 2003 with weakness and cramping in the bilateral lower extremities and mild difficulty walking. Brain and spinal MRI were reportedly normal. His difficulty walking rapidly progressed. He later developed dysphagia that progressed from no reported problems in May 2004 to pill swallowing difficulties in September 2004 to gastrostomy tube placement in Spring 2005. Dysarthria was apparent from December 2004. Respiratory difficulties were documented from March 2005 when he required nasal ventilation at night and experienced shortness of breath during the day. He took Rilutek for the first sixth months, but this was discontinued in the fall of 2004 due to elevated liver enzymes. He was on Baclofen and quinine throughout his course. He presented to Barnes-Jewish Hospital with abdominal pain in May 2005 and developed respiratory symptoms shortly thereafter. He subsequently developed pneumonia that required intubation. He died in May 2005. ---- At autopsy the weight of the unfixed brain was 1480 g. Specifically, there was no general cortical atrophy or selective atrophy of the motor cortex.
