A 47-year-old man was presented with a 1-year history of progressive, repetitive, involuntary muscle twitching and cramps in his legs. He had difficulty swallowing solids and liquids, and he also noted excessive salivation and decreased the volume of his tone. His medical history was otherwise unremarkable. Examination Neurologic examination revealed mildly slurred speech, tongue atrophy (attached image), and fasciculations and weakness of the sternocleidomastoid muscle. Wasting of the intrinsic hand muscles, generalized hyperreflexia, and bilateral foot drop was also noted.
Electromyography indicated active and chronic denervation. What is the likely diagnosis for this patient? *This case is from Docplexus editorial team for educative purpose only. Source: NEJM Stay Connected, the answer will be posted in the next 48h!
