A 74-year man presented with difficulty in climbing stairs, difficulty in getting up from squatting posture for last 2-3 months, difficulty in protruding tongue and feelings heaviness of tongue for 2 months however, no difficulty in swallowing and respiratory distress. He is not a known HTN or diabetic, smoker and social drinker, not on any drugs, affluent economic status. Exam revealed mildly anemic, b/l pedal edema bp 140/80, pule 90/min regular.
His higher mental function and cranial nerve exam normal, motor exam proximal weakness muscle power 4-/5 upper limb and 4/5loew limbs, mild distal pinprick and cotton wool sensation impairment however reflexes are well-preserved planters bilateral upgoing. CVS/CHEST /PA reveal no abnormality. Investigation HB 9.2 mg% ca++ 8.2 mg% TLC, platelet count, BS both fasting and pp HBA1C , LFT, RFT WNL, urine exam -protein + sugar nil, few pus cells…
