History 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. Past medical history is notable for hypertension for 15 years and 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. 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…
