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Neurological Rehabilitation

From Fall to Right Call: A Case Report on the Diagnosis of Amyotrophic Lateral Sclerosis in a Traumatic Brain Injury Patient with Progressive Right-Sided Weakness

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 6

    Primary Author(s)

  • Victoria Nguyen, DO (she/her/hers)

    Resident Physician
    McGaw Medical Center of Northwestern University/Shirley Ryan AbilityLab (SRAL) PM&R Program
    Chicago, Illinois

    • Co-Author(s)

  • Kian Nassiri, DO

    Brain Injury Attending Physician and Assistant Professor
    Shirley Ryan AbilityLab/Northwestern University
    Chicago, Illinois

Disclosure(s):
Victoria Nguyen, DO: No financial relationships to disclose
Kian Nassiri, DO: No financial relationships to disclose
Case Diagnosis: A patient with a traumatic brain injury (TBI) with progressive right-sided weakness was diagnosed with amyotrophic lateral sclerosis (ALS) on electromyography/nerve conduction study (EMG/NCS).

Case Description or Program Description: A 75-year-old female with history of cervical stenosis and myelopathy status post C2-C4 laminectomy, C2-C6 posterior cervical fusion (4/2024) complicated by recent right arm weakness thought to be secondary to superimposed right C5-8 radiculopathy and carpal tunnel syndrome (EMG 9/2024), presented to rehabilitation on 10/2024 following a fall on 9/2024 with left temporal, parietal, and occipital subdural hemorrhage (SDH).

Setting: Acute inpatient rehabilitation

Assessment/Results: During inpatient rehabilitation, progressive functional decline in right upper extremity strength was noted with stable neuroimaging. Exam was significant for asymmetric right upper extremity weakness, hyperreflexia, and limb atrophy. Inpatient EMG conducted 11/2024 raised concern for motor neuron disease due to electrodiagnostic evidence of active denervation and chronic reinnervation changes in multiple cervical (C5-T1), lumbar (L3-S1) myotomes and the right trapezius. Active denervation was also noted in the left rectus abdominis. Repeat outpatient exam on 1/2025 noted spastic dysarthria, tongue fasciculations, facial weakness, diffuse limb weakness, hyperreflexia and atrophy with repeat EMG showing active denervation and chronic reinnervation in multiple myotomes of the right lumbosacral segment and in the cranial segment. In conjunction with the prior EMGs, this was diagnostic of ALS by El Escorial criteria.

Discussion (relevance): Estimated worldwide incidence of ALS is 1-2.6 cases per 100,000 people annually. There are few reported cases of ALS being diagnosed in a TBI patient during inpatient rehabilitation.

Conclusions: It is imperative for physiatrists to recognize ALS in patients with complex progressive symptoms as early identification is key to coordinating rehabilitation to help ALS patients maintain function, manage symptoms, and improve quality of life through multidisciplinary care.