Case 1 History ---- The patient was a 75yo man with a 9 year slowly progressive course of ALS with predominately bulbar and upper motor neuron symptoms who, at the time of his last visit, was wheelchair bound and anarthric with minimal use of his arms. He had severe spastic dysarthria and on exam had tongue atrophy and fasciculations. Three days before his death he was hospitalized with progressively worsening respiratory status (he had previously declined assisted ventilation), particularly over the prior week. He elected for hospice care and died shortly thereafter. ---- At autopsy the unfixed brain weighed 1450 g. The external surface of brain and coronal sections appeared unremarkable with no evidence of selectively atrophy of the precentral gyrus. ---- 1A1 A difference in caliber and color is noted between the dorsal roots (combed to the left) and the atrophic ventral spinal roots (combed to the right) - some more fragile ventral roots did not survive dissection. The normal dorsal roots are typically a bit larger than ventral normally.
