Amyotrophic Lateral Sclerosis (ALS) is a debilitating, uniformly fatal disease. While it most commonly presents with limb weakness, patients may also present with neurocognitive, respiratory, or bulbar symptoms. Despite its poor prognosis, an early diagnosis can save patients from unnecessary and expensive testing, lead to interventions that improve quality of life, and give patients and family time for advanced planning.1 This case highlights an unusual presentation of ALS.


  • Our patient presented with chronic cough and restrictive lung disease and after extensive workup was diagnosed with ALS.
  • Bulbar and respiratory symptoms are uncommon initial presentations of ALS.
  • Early diagnosis of ALS can allow for advanced care planning and help patients initiate treatment earlier which can lead to improved quality of life.