A 67-year-old man is referred to a neurologist by his general practitioner (GP). His symptoms are of weakness and wasting of the muscles of his left hand. He has noticed the weakness is worse after using his hand, for example, after using a screwdriver. He has also noticed cramps in his forearm muscles. On a few occasions recently, he has felt choking sensations after taking fluids. PMH Hypertension for 15 years and a myocardial infarction three years earlier.
Medication consists of simvastatin, aspirin, and atenolol Examination Blood pressure is 146/88 mmHg. There are no abnormalities in the cardiovascular or respiratory systems or the abdomen. There is some wasting of the muscles in the upper limbs, particularly in the left hand. There is some fasciculation in the muscles of the forearms bilaterally. Power is globally reduced in the left hand and slightly reduced in the right hand.…
