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| LETTER TO EDITOR |
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| Year : 2009 | Volume
: 57
| Issue : 3 | Page : 354-355 |
'Garland sign' in amyotrophic lateral sclerosis
Atma Ram Bansal1, Gopal Krishna Dash1, Ashalatha Radhakrishnan1, Chandrasekharan Kesavadas2, Muraleedharan Nair1
1 Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
2 Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| Date of Acceptance | 31-Mar-2009 |
| Date of Web Publication | 8-Jul-2009 |
Correspondence Address:
Chandrasekharan Kesavadas
Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.53273
How to cite this article:
Bansal AR, Dash GK, Radhakrishnan A, Kesavadas C, Nair M. 'Garland sign' in amyotrophic lateral sclerosis. Neurol India 2009;57:354-5 |
Sir,
A 37-year-old lady presented with pure motor, asymmetrical onset, progressive quadriparesis with wasting of hands and feet of one year duration, with dysphagia, dysarthria, and emotional incontinence of four months duration. On examination, she had upper motor neuron (UMN) and lower motor neuron (LMN) signs in bulbar muscles, upper and lower limbs without involvement of extraocular movements. Rest of the neurological examination was normal. She satisfied the El Escorial criteria for definite amyotrophic lateral sclerosis (ALS). Her electrodiagnostic studies showed evidence of preganlionic neurogenic lesion involving bulbar, cervical, thoracic, and lumbosacral spinal segments. Her work up for secondary causes of anterior horn cell disease was negative.
She was evaluated with magnetic resonance imaging (MRI) of the brain and spinal cord . MRI brain showed all the characteristic features of ALS including T2 hyperintensity extending along corticospinal tract from centrum semiovale to crus cerebri bilaterally. T2 hypointensity was noted in precentral gyrus. MRI cervical spine showed T2 hyperintensity involving the anterolateral column of the spinal cord. The coronal T2 image was forming a characteristic 'garland pattern' of hyperintensity extending along corticospinal tracts as well as involving corpus callosum [Figure 1]. This peculiar imaging appearance has hitherto not been reported in a classical case of ALS. T2-weighted image showing high signal intensity involving the corticospinal tract extending into the anterolateral column of the spinal cord has been described. [1] Involvement of the corpus callosum has also been reported. [2] In addition, T2-weighted MRI typically demonstrates low signal intensity in the motor cortex; this finding has been attributed to T2 shortening due to iron deposition. [1] A lesion distribution simulating a garland has been described with Alexander disease, metastatic colorectal adenocarcinoma, and acute postinfectious glomerulonephritis. [3],[4],[5]
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| 3. | Van der Knaap MS, Ramesh V, Schiffmann R, Blaser S, Kyllerman M, Gholkar A, et al. Alexander disease: Ventricular garlands and abnormalities of the medulla and spinal cord. Neurology 2006:66:494-8. |
| 4. | Lewis MR, Deavers MT, Silva EG, Malpica A. Ovarian involvement by metastatic colorectal adenocarcinoma: Still a diagnostic challenge. Am J Surg Pathol 2006;30:177-84. [PUBMED] [FULLTEXT] |
| 5. | Sorger K, Gessler U, Hübner FK, Kφhler H, Schulz W, Stühlinger W, et al. Subtypes of acute postinfectious glomerulonephritis. Synopsis of clinical and pathological features. Clin Nephrol 1982;17:114-28. |
[Figure 1]
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