Motor neuron disease mimics in practice: a case series

Area of Science:

• Neurology
• Oncology
• Immunology

Background:

• Motor neuron disease (MND) diagnosis is typically clinical and straightforward.
• Accurate differentiation of treatable conditions mimicking MND is crucial due to the condition's severity.

Observation:

• Case 1: A man with swallowing difficulties, speech problems, and foot drop, initially suspected as MND, was diagnosed with a tonsillar tumor.
• Case 2: An elderly man with progressive unilateral leg weakness and fasciculations was diagnosed with a high-grade brain glioma.
• Case 3: An elderly woman with progressive quadriparesis and EMG findings suggestive of denervation was diagnosed with anti-GD1a motor neuropathy.

Findings:

• The tonsillar tumor in Case 1 was treated, leading to improvement in foot drop.
• The brain glioma in Case 2 required specific oncological management.
• Case 3 showed a positive response to immunotherapy (intravenous immunoglobulin, cyclophosphamide, rituximab) and achieved remission.

Implications:

• These cases underscore the importance of considering and investigating treatable mimics in suspected motor neuron disease.
• Early and accurate diagnosis of MND mimics can lead to effective treatment and improved patient outcomes.
• Highlighting rare presentations of neurological disorders aids clinicians in differential diagnosis and management strategies.