Lower motor neuron disease with snake eyes sign
A new clinical-radiological entity
Keywords:
Motor neuron disease, Spinal cord diseases, Differential diagnosis, Magnetic resonance imagingAbstract
Lower motor neuron diseases are a heterogeneous group of entities with different prognosis. The “snake eyes” sign refers to bilateral hyper intensity of the anterior horns on axial magnetic resonance imaging of the spinal cord. It has been associated with ischemia, cervical spondylosis, Hirayama disease, and amyotrophic lateral sclerosis. Recently, a small number of cases of lower motor neuron disease associated with the “snake eyes” sign have been described as having distinctive clinical manifestations and prognosis.
Two young patients with “snake eyes” sign associated with lower motor neuron disease had a progressive initial course followed by a stabilization of symptoms without involvement of upper motor neuron. They presented with asymmetric segmental arm weakness with distal predominance in the first a case and proximal predominance in the second.
These cases match with those reported in the literature giving support to lower motor neuron disease with “snake eyes” as a pathological entity with a relatively good prognosis. This diagnosis should avoid unnecessary treatments.
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