Acute Respiratory Failure as Initial Presentation of Amyotrophic Lateral Sclerosis Onset

SummaryAmyotrophic lateral sclerosis (ALS) is a progressive, unrelenting and presently incurable neurodegenerative disorder. Respiratory muscle involvement is often a late complication of ALS. Only 1–3% of patients with ALS presenting to a tertiary care center had respiratory symptoms as their initial clinical symptom. In addition, only 14% of these individuals presented acutely and required emergency intubation. We report a 75-year-old female whose initial presentation at our emergency department was dyspnea. Dyspnea worsened and progressed to acute respiratory failure. There was no definite cause of respiratory failure found initially. However, ALS was diagnosed after physical and neurologic examination and electrodiagnostic studies. Respiratory muscle weakness was her first presentation of ALS.