{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:14:47Z","timestamp":1791296087403,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2014,5,22]],"date-time":"2014-05-22T00:00:00Z","timestamp":1400716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Investissements davenir ANR-10-IAIHU-06"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>The \u2018snake eyes\u2019 sign refers to bilateral hyperintensities of the anterior horns on axial spinal cord imaging. Based on sporadic reports, it has been associated with a range of lower motor neuron (<jats:styled-content style=\"fixed-case\">LMN<\/jats:styled-content>) syndromes, such as spondylotic amyotrophy and Hirayama disease, as well as spinal cord infarction. The objective of our study was to comprehensively characterize the full diagnostic spectrum of <jats:styled-content style=\"fixed-case\">LMN<\/jats:styled-content> syndromes with this radiological clue and discuss potential aetiological factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A large patient cohort with snake eyes sign and upper limb <jats:styled-content style=\"fixed-case\">LMN<\/jats:styled-content> degeneration was recruited from three <jats:styled-content style=\"fixed-case\">F<\/jats:styled-content>rench neuromuscular units. Patients underwent detailed electrophysiological, radiological, clinical and anamnestic profiling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010nine patients were ascertained and followed up for 9.5\u00a0\u00b1\u00a08.6\u00a0years. The majority of the patients were male (86.2%) with a mean age of 37.3\u00a0\u00b1\u00a014.4\u00a0years. Symptoms were bilateral in most cases (86.2%). Patients with predominantly proximal and distal deficits were equally represented (44.8% and 55.2%, respectively). A history of preceding trauma or intense physical activity was confirmed in 58.6% of the cases; 27.6% of the patients were given an initial clinical diagnosis of amyotrophic lateral sclerosis (<jats:styled-content style=\"fixed-case\">ALS<\/jats:styled-content>), and 51.7% were originally suspected to have multifocal motor neuropathy. None of the patients developed <jats:styled-content style=\"fixed-case\">ALS<\/jats:styled-content> on longitudinal follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The snake eyes sign on magnetic resonance imaging is associated with a wide spectrum of neurological conditions and is more common in young men with a history of strenuous activity or antecedent trauma. The recognition of this syndrome is crucial as many of these patients are initially misdiagnosed with <jats:styled-content style=\"fixed-case\">ALS<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.12465","type":"journal-article","created":{"date-parts":[[2014,5,22]],"date-time":"2014-05-22T08:51:05Z","timestamp":1400748665000},"page":"1233-1241","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Revisiting the spectrum of lower motor neuron diseases with snake eyes appearance on magnetic resonance imaging"],"prefix":"10.1111","volume":"21","author":[{"given":"M.\u2010V.","family":"Lebouteux","sequence":"first","affiliation":[{"name":"Service de Neurologie HIA du Val de Gr\u00e2ce Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Franques","sequence":"additional","affiliation":[{"name":"Centre de R\u00e9f\u00e9rence des Maladies Neuromusculaires et de la SLA 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