{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:20:10Z","timestamp":1788441610395,"version":"build-2803163510"},"reference-count":22,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,6,26]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Amyotrophic lateral sclerosis (ALS) is a rare disease caused by the destruction of motor neurons, typically presenting with unilateral lower motor neuron and upper motor neuron symptoms. Here, we report the case of a female in her mid-60s with a complex history of lower extremity weakness following a motor-vehicle collision 3 years before her current presentation with a subacute complaint of right-sided leg weakness. With an atypical symptom course consisting of resolved and recurrent weakness of her left leg, the patient had multi-level chronic, evolving spinal-column damage, severe weight loss, newly discovered rectal neoplasm and longstanding psychiatric pathology. With symptoms concerning for both medical and psychosomatic explanations, several potentially compounded aetiologies were considered. Here, we discuss important considerations for fluctuating chronic and subacute neurological complaints with a broad differential diagnostic spectrum and how a macro-perspective of symptoms over years can aid in the diagnosis of a challenging ALS presentation.<\/jats:p>","DOI":"10.1136\/bcr-2026-272139","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:35:17Z","timestamp":1783593317000},"page":"e272139","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Unusual presentation of amyotrophic lateral sclerosis years after a motor-vehicle collision"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2227-6983","authenticated-orcid":false,"given":"Dean M","family":"Pucciarelli","sequence":"first","affiliation":[{"name":"Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radha","family":"Patel","sequence":"additional","affiliation":[{"name":"Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Sawicki","sequence":"additional","affiliation":[{"name":"Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saloni","family":"Jain","sequence":"additional","affiliation":[{"name":"Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Saulino","sequence":"additional","affiliation":[{"name":"Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"2026090306052403000_19.7.e272139.1","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1080\/21678421.2024.2447919","article-title":"Amyotrophic lateral sclerosis estimated prevalence cases from 2022 to 2030, data from the national ALS Registry","volume":"26","author":"Mehta","year":"2025","journal-title":"Amyotroph Lateral Scler Frontotemporal Degener"},{"key":"2026090306052403000_19.7.e272139.2","doi-asserted-by":"crossref","first-page":"453","DOI":"10.3109\/21678421.2014.903974","article-title":"Diagnostic timelines and delays in diagnosing amyotrophic lateral sclerosis (ALS)","volume":"15","author":"Paganoni","year":"2014","journal-title":"Amyotroph Lateral Scler Frontotemporal Degener"},{"key":"2026090306052403000_19.7.e272139.3","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2013.203"},{"key":"2026090306052403000_19.7.e272139.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1412082"},{"key":"2026090306052403000_19.7.e272139.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31287-4"},{"key":"2026090306052403000_19.7.e272139.6","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(21)00465-8"},{"key":"2026090306052403000_19.7.e272139.7","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0000000000000730"},{"key":"2026090306052403000_19.7.e272139.8","doi-asserted-by":"crossref","unstructured":"Chio A , Logroscino G , Hardiman O , et al . Prognostic factors in ALS: A critical review. Amyotroph Lateral Scler Off Publ World Fed Neurol Res Group Mot Neuron Dis. 2009;10:310\u201323. doi:10.3109\/17482960802566824","DOI":"10.3109\/17482960802566824"},{"key":"2026090306052403000_19.7.e272139.9","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30054-1"},{"key":"2026090306052403000_19.7.e272139.10","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1016\/S0140-6736(96)91680-3","article-title":"Dose-ranging study of riluzole in amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis\/Riluzole Study Group II","volume":"347","author":"Lacomblez","year":"1996","journal-title":"Lancet Lond Engl"},{"key":"2026090306052403000_19.7.e272139.11","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2021-003256"},{"key":"2026090306052403000_19.7.e272139.12","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27392"},{"key":"2026090306052403000_19.7.e272139.13","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2006.098798"},{"key":"2026090306052403000_19.7.e272139.14","doi-asserted-by":"crossref","DOI":"10.3390\/ijms232415521","article-title":"Sensory Involvement in Amyotrophic Lateral Sclerosis","volume":"23","author":"Rubio","year":"2022","journal-title":"Int J Mol Sci"},{"key":"2026090306052403000_19.7.e272139.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2020.08.027"},{"key":"2026090306052403000_19.7.e272139.16","doi-asserted-by":"crossref","DOI":"10.3390\/brainsci12081053","article-title":"Paraneoplastic Amyotrophic Lateral Sclerosis: Case Series and Literature Review","volume":"12","author":"Yang","year":"2022","journal-title":"Brain Sci"},{"key":"2026090306052403000_19.7.e272139.17","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-012-0089-5"},{"key":"2026090306052403000_19.7.e272139.18","doi-asserted-by":"crossref","first-page":"577635","DOI":"10.1016\/j.jneuroim.2021.577635","article-title":"A paraneoplastic syndrome misdiagnosed as ALS: What are the red flags? A case report and review of the literature","volume":"358","author":"Tolkovsky","year":"2021","journal-title":"J Neuroimmunol"},{"key":"2026090306052403000_19.7.e272139.19","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1212\/WNL.0000000000002671","article-title":"Depression in amyotrophic lateral sclerosis","volume":"86","author":"Roos","year":"2016","journal-title":"Neurology"},{"key":"2026090306052403000_19.7.e272139.20","article-title":"Epidemiological Features and Clinical Manifestations of Patients With Somatoform Disorder at a Tertiary Medical City in Riyadh, Saudi Arabia","volume":"13","author":"Alanazi","year":"2021","journal-title":"Cureus"},{"key":"2026090306052403000_19.7.e272139.21","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-231550","article-title":"Somatic symptom disorder: a diagnostic dilemma","volume":"12","author":"Dunphy","year":"2019","journal-title":"BMJ Case Rep"},{"key":"2026090306052403000_19.7.e272139.22","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26045"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272139","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:05:33Z","timestamp":1788440733000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272139"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":22,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,9]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bcr-2026-272139"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272139","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}