Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease. 70% of the affected individuals develop the spinal form of the disease, while 30% develop bulbar changes. 85% of the individuals with spinal form of the disease develop bulbar changes as a result of disease progression. Bulbar form of ALS is associated with a poorer prognosis (average survival rate less than two years) and lower quality of life. We report the case of a 76 years old female presenting with dysphonia and mild dysphagia following laparoscopic cholecystectomy with general anesthesia (Jan. 2017). Past medical history was not significant. Immediate neurological examination reveals dysphonia and moderate dysphagia, present pharyngeal reflex and no significant motor impairment. Blood tests (biochemistry, HIV serology, hepatitis B, C and syphilis testing, CK, Ab antiMuSK, Ab-antiACH, Ab antineuronals, neoplasic markers) were negative. Cerebral CT and MRI reveals a mild cortical atrophy without significant changes. ENG and needle guided EMG examination was performed, revealing specific changes with moderate axonal degeneration of the right peroneus muscle, rich spontaneous potentials and decreased recruitment. Possible bulbar form of ALS is diagnosed and Riluzole (2*5 mg/day) treatment was started. The patient developed general muscular weakness and atrophy, swallowing difficulties and finally respiratory insufficiency, dying 22 months after initial diagnosis. Our case reported shows particular bulbar form of ALS in an elderly patient following general anesthesia associated with a severe prognosis and significant impairment.