differential diagnosis

Last reviewed 01/2018

Other diseases which lead to muscular wasting, especially of the upper limbs, must be considered:

  • syringomyelia - fasciculations are rare; dissociated sensory loss from an early age
  • intramedullary tumour - sensory loss usually prominent
  • cervical spondylosis - sensory loss is usually present but the upper limb weakness and lower limb spasticity may be remarkably similar to MND. MND has a more rapid myelopathy and cervical disc protrusion will be absent on X-ray. Occasionally, MND may co-exist with cervical spondylosis.
  • cervical rib - fasciculation absent, pain prominent, sensory loss usually present, characteristic radiology
  • peripheral nerve lesions - localised wasting, usually accompanied by sensory loss.
  • peroneal muscular atrophy - sensory loss
  • chronic polymyositis - differentiate by electromyography and muscle biopsy
  • myasthenia gravis - bulbar signs but rarely muscular wasting; responds rapidly to anticholinesterase