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To the Editor:
Bianco et al. report MRI abnormalities after hepatic transplantation.1 Rovira et al. described similar corticospinal tract (CST) hyperintesities in cirrhosis that resolved with hepatic transplantation,2 and both studies may clarify selective cortical vulnerability in disease.
In both cases, the changes were strikingly similar to CST abnormalities noted in cases of ALS.3 Clinically, CST involvement in ALS varies and such MRI findings are considered poor sensitivity and specificity indicators. However, Bianco et al.’s finding of frontal lobe abnormalities in the setting of hepatic disease is a further area of overlap with the cortical lesion in ALS, where a clear spectrum of frontal lobe involvement is now acknowledged, even within the majority of cases (who do not develop frank …
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