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Anterior horn cell diseases are a group of pure motor disorders involving both upper and lower motor neurons. They are currently untreatable and carry variable course based on the phenotype. The nervous system is vulnerable for oxidative stress due to its high oxygen consumption, low antioxidants, poor regenerative capacity, and presence of metal ions. A 36‑year‑old female had exertion induced cramps of her right lower limb, coldness in the right lower limb, progressive weakness, wasting, and fasciculation; became bilateral within 4 years. She had cyanosis, hypothermia, and decreased sweating of right leg with psoriasis. Her nerve conduction and electromyography studies were suggestive of anterior horn cell disease, which was supported by histopathology. She had severe reduction in total volume of sweat produced and prolonged sweat latency on the right‑sided limbs as assessed by Quantitative sudomotor axon reflex test. DNA testing showed SOD1 cytogenetic band exon 4 of the SOD1 gene. chr. 21:33039650c>C/T; c. 319c>C/T. We report a new phenotype in dominantly inherited amyotrophic lateral sclerosis, with asymmetrical vasomotor and sudomotor changes and psoriasis.

New Phenotypic and Genotype SOD1 Mutation in Dominant Familial Motor Neuron Disease: A Case Report of a Family