iatroX Rounds #27
The clues
- 1
A 62-year-old man presents with progressive weakness in his right hand that started four months ago.
- 2
He has noticed that he is increasingly clumsy, tripping over his feet and dropping his car keys.
- 3
His wife has commented that his speech has become slightly slurred and nasal in quality over the last few weeks.
- 4
Examination reveals muscle wasting and visible twitching in the deltoids and tongue, with brisk reflexes and an extensor plantar response.
- 5
Sensation is entirely normal across all limbs, and a brain and whole-spine MRI show no evidence of cord compression or structural lesions.
- 6
Electromyography demonstrates widespread acute and chronic denervation across multiple body regions including the cervical, thoracic and lumbosacral segments.
Motor neurone disease is a progressive neurodegenerative condition characterized by the loss of both upper and lower motor neurones. It typically presents with a combination of muscle wasting, weakness, and spasticity without sensory involvement.
- Combination of upper and lower motor neurone signs
- Absence of sensory signs or symptoms
- Tongue fasciculations and wasting
- Progressive bulbar palsy and limb weakness
for education and entertainment. not medical advice.