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Polymyositis masquerading as motor neuron disease.

Aisling Ryan1, Azli M Nor, Donal Costigan

  • 1Department of Neurology, National Institute for Neurology and Neurosurgery, Beaumont Hospital, Dublin, Ireland.

Archives of Neurology
|July 23, 2003
PubMed
Summary

Polymyositis can mimic motor neuron disease (MND), especially with bulbar symptoms. Early diagnosis requires electromyography and muscle biopsy, not just clinical signs, to differentiate from MND.

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Area of Science:

  • Neurology
  • Immunology

Background:

  • Misdiagnosis of motor neuron disease (MND) is a frequent clinical challenge.
  • Various conditions can present with symptoms overlapping those of MND.

Observation:

  • A 73-year-old woman presented with acute dysphagia and oropharyngeal weakness, initially suspected as MND.
  • Clinical findings included nasal dysphonia, subtle limb weakness, brisk reflexes, and fasciculations.
  • Initial laboratory tests, including serum creatine kinase, were unremarkable.

Findings:

  • Electromyography revealed a myopathic process, distinguishing it from neurodegeneration.
  • Muscle biopsy confirmed polymyositis as the diagnosis.
  • The patient's dysphagia resolved rapidly with corticosteroid and azathioprine treatment.

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Implications:

  • Bulbar-onset polymyositis can present as a diagnostic mimic of MND.
  • Clinical evaluation of bulbar dysfunction requires careful consideration.
  • Electromyography and muscle biopsy are crucial for accurate diagnosis and appropriate treatment of suspected MND.