If we were looking at familial ALS what would you also expect in a low power picture of spinal cord? Answer more extensive involvement which includes ascending pathways like the dorsal columns. You might also see distended proximal neuronal process filled with neurofilamentous aggregates similar to neurofibrillary tangles. In what form of ALS are neurofibrillary tangles commonly seen? Patients with the Guam ALS/ Parkinson’s/Dementia Complex. What etiological clues may come from geographic foci of high prevelance? What clues come from recent genetic findings concerning familial ALS in our part of the world? Think it over. If I write all of it out, I will have written a book!

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