Diffuse Pleural Mesothelioma : Metastases to the Distand Visceral Organs and Thyroid Adenomas.

A case of the Vulpian Bernhardt type of spinal progressive muscular atrophy was reported. The patient was 65-year-old male, who developed progressive difficulty in washing his face and dressing because of weakness of shoulder girdle muscles. Physical examination revealed muscle weakness and wasting in the proximal part of the upper extremities. The muscle of the forearms were relatively spared. The affected muscls showed muscle fasciculation and hypoactive spared. The affected muscls showed muscle fasciculation and hypoactive deep reflexes. His family history was completely regative for any neurological diseases. The mainly involved site was suspected to be the anterior horn cell or secondary motor neuron in the spinal cord. This case was interpreted as an intermediate form between spinal progressive muscular atrophy, proximal type of amyotrophic spinal progressive muscular atrophy, proximal type of amyotrophic lateral sclerosis and adult type of Wohlfart-Kugelberg-Wellander's disease. The problems in differential diagnosis of these motor neuron diseases were discussed.