Serial MRI findings in a case of primary lateral sclerosis

A patient with primary lateral sclerosis (PLS) underwent MRI 3 times over 8.5 years. These images demonstrate progressive atrophy of the premotor, parietal, and primary sensorimotor cortex, with sparing of the temporal lobe, occipital lobe, and cerebellum. The pattern of cerebral atrophy was clearly restricted but was more extensive than expected from sensorimotor cortex pyramidal cell loss described in literature autopsy reports of PLS. Cortical motor system degeneration in PLS, whether primary or secondary, may be more extensive than previously believed.