A 25-year-old man presented with a 4 years’ history of slowly progressive weakness and atrophy that started in the right hand and forearm. He complained of tremulousness of both hands for the past one year that gradually progressed to involve both lower limbs within the next 6 months. The tremors resulted in severe disability in performing daily activities involving his hands like writing. He also developed excessive sweating of both palms. Medical History: There was no history of neck pain, sensory involvement, difficulty in walking, dysphagia, diplopia, or bowel or bladder involvement.
His past medical history was noncontributory. There was no trauma to the neck, exposure to toxins, or any allergies. None of his family members had a similar complaint. Neurological examination: Investigations revealed features suggestive of both upper and lower motor neuron lesions. Both forearms and…
