Case presentation A 67-year-old retired university lecturer was referred to a neurologist. He felt weakness in his left hand and cramps in the forearm. Also, he stated that weakness was worse after using his hand, for instance, after using a screwdriver. In addition, his speech was slightly slurred, and he started choking after taking fluids.
Medical history The patient had a history of hypertension for 15 years and myocardial infarction for three years. He was on medication, including simvastatin, aspirin, and atenolol. He is a non-smoker and drinks a bottle of wine a week. Examination Blood pressure - 146/88 mm Hg No abnormalities in the cardiovascular or respiratory systems or the abdomen Wasting of the muscles in the upper limbs (left hand) Fasciculation in the muscles of the upper arms bilaterally Muscle tone is normal The biceps and triceps jerks are brisk bilaterally without any…
