Brachial Amyotrophic Diplegia: A Case Report

Case Diagnosis: 63 year old male who has not seen a physician in over 6 years presented with progressive arm weakness and shortness of breath over the course of a year, found to have brachial amyotrophic diplegia.

Case Description or Program Description: He did not see a physician over the year of his progressive symptoms. Patient was living at home independent with ADLs but progressively began to struggle performing tasks. He went to the ED due to decline in pulmonary function. On exam, Patient had fasciculations in bilateral forearms and neck. bilaterally: 0/5 strength shoulder abduction, 1/5 elbow flexion, 2/5 elbow extension, 0/5 wrist extension, 2/5 wrist flexion. Lower extremity strength bilaterally: 4/5 hip flexion, 3/5 dorsiflexion.

Setting: Inpatient rehabilitation facility.

Assessment/Results: FVC 16% of predicted. cervical MRI was unremarkable. EMG: demonstrated diffuse denervation and reinnervation in lower extremities, upper extremities, and in the genioglossus

Discussion (relevance): This case displays a rare variant of ALS being brachial amyotrophic diplegia which highlights the importance of a broad differential diagnosis for a patient with upper extremity weakness with the utility of electrodiagnostic testing to support the diagnosis. Additionally, this case highlights the types of therapies to be implemented in a patient with motor neuron disease

Conclusions: Patient continued at inpatient rehab focusing on energy conservation and pulmonary rehab. Ultimately, patient was discharged to a ALS tertiary care center for further management.