Mri findings revealed abnormal signal on corticospinal tract, as seen at typical als, and no other abnormalities6. can i buy viagra over the counter in india This finding was uncommon, once brain imaging studies in patients with logm2 generally show severe cerebellar atrophy7. Pls is another rare disorder, characterized by a slowly progressive symmetrical pyramidal deficit occurring in the absence of muscle wasting and in which no other cause for the neurological dysfunction can be established8. buying viagra online illegal The differential diagnosis for progressive corticospinal spasticity is challenging. Many disorders, such as inherited illnesses or conditions with sensory symptoms or more generalized neurologic impairment, could be eliminated readily after a careful history and examination. buy generic viagra Actually, if a patient presents with slowly progressive spinobulbar spasticity in the absence of other findings, the differential diagnosis is limited. viagra cost thailand The hereditary spastic paraplegias and familial als merit particular consideration4. If the patient is less than 40 years of age, hex a levels could be of value to diagnose logm2, which may be quite difficult to distinguish from als on clinical examination. Although the motor manifestations of our patient were typical of a mnd, some associated findings impelled us to find an alternative diagnosis: early manifestation, slow course and bilateral vi nerve palsy. The clinical features described in patients with hex a deficiency and motor neuron symptoms include early onset, positive family history, and/or long disease duration1-3,5. Previous reports failed to reveal significant hex a deficiency among als patients. In one study, the frequency of mutations in the hex a gene among israeli als patients was not higher than in the healthy israeli population5. In another one, hex a activity determined in isolated peripheral blood leukocytes was screened in als patients, and was normal in all typical als patients9. viagra generic In both studies there is no data regarding pls. cheap viagra online This case report highlights that hex a deficiency can mimic not only als, but also pls. viagra grapefruit juice effects We believe that the screening for hex a deficiency should always be considered in atypical cases of mnd.   references 1. Navon r, argov z, frisch a. Hexosaminidase a deficiency in adults. Am j med genet 1986;24:179-196.         [ links ] 2. Shapiro be, logigian el, kolodny eh, pastores gm. order viagra Late-onset tay-sachs disease: the spectrum of peripheral neuropathy in 30 affected patients. what is viagra pills used for Muscle nerve 2008;38:1012-1015. cheap generic viagra         [ links ] 3. Neudor. generic viagra online Representaciones
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