A 67-year-old man presented with 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. Past medical history is notable for hypertension for 15 years and a myocardial infarction 3 years previously. Medication consists of simvastatin, aspirin and atenolol. He is a retired university lecturer.
He lives with his wife, and they have two grown-up children. He is a non-smoker and drinks a bottle of wine a week. 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…
