Fulminant amyotrophic lateral sclerosis manifesting in a young woman during pregnancy

Abstract

A 25-year-old woman presented with marked weakness of her hands and legs resulting in gait abnormalities and impaired self-service. She also complained of involuntary twitching and cramping in the muscles of the trunk and limbs, widespread muscle wasting, feeling of “a lump in the throat,” dyspnea, and fatigue. Her history was unremarkable for any personal or family history of neurological diseases. She held a Bachelor’s Degree in Mine Engineering but had never been employed in the related fields. She first noted weakness in her hands, the left more than the right, in June 2018, in the 6th month of her pregnancy. In the 8th month of pregnancy, the patient developed dyspnea, weakness in the lower limbs, and difficulties walking. She was thoroughly evaluated by a neurologist; her neuroimaging was unremarkable, and nerve conduction study showed signs of demyelination. She was diagnosed with chronic inflammatory demyelinating polyneuropathy. At week 38 of the pregnancy, the patient delivered a healthy baby by a scheduled cesarean section and received pulse IV methylprednisolone, with no clinical improvement. She was re-diagnosed with multifocal motor neuropathy and treated with a course of IV immunoglobulin, which resulted in no improvement.