A 60-year-old female with a known case of hypertension presented to the clinic with a history of
slurring speech for three days. Slurring of speech was associated with the deviation of the tongue to
the left side. She also had difficulty swallowing which developed initially for solid food, then
progressed to semi-solid foods reflecting the progressive nature of the disease. She had normal
bowel movements and bladder habits. The vital signs of the patient were stable. On examination of
the nervous system higher mental function, motor and sensory systems were intact with a normal
plantar response. However, the tongue deviated to the left side with fasciculations.
Results
b) Bulbar onset Amyotrophic Lateral Sclerosis
Amyotrophic Lateral Sclerosis is a neurodegenerative disorder that is usually characterized by
progressive muscle paralysis. The foremost symptom can be either spinal or bulbar. The spinal
presentation is generally stumbling or weakness of grasp whereas the bulbar presentation is slurred
speech, dysphagia, and facial weakness. In this case, the patient had the foremost symptoms of
bulbar components like acute slurring of speech with the tongue deviated to the left side and
progressive dysphagia. The patient has been treated with an injection of Edaravone 60 mg via the
Intravenous route once daily for 14 days. Despite treatment patients with bulbar symptoms have
short survival, lessened quality of life, and immediate functional deterioration. ALS with bulbar onset
can have a poor prognosis and would require a multidisciplinary approach to the treatment.
