Progressive Weakness and Fasciculations

🗒️ Question

A 64 year old man presents to his GP with a 6 month history of progressive weakness in his right hand. He reports frequent muscle cramps and occasional twitching which he describes as “jumping” muscles. Over the past month he has noticed increased difficulty swallowing solid foods. He denies any sensory changes or cognitive symptoms.

On examination, there is wasting of the intrinsic muscles of the right hand, mild dysarthria and fasciculations in both upper limbs. Reflexes are brisk in both arms and legs with upgoing plantar responses bilaterally. Sensation is intact.

• Investigations:

  • Nerve conduction studies: Normal

  • Electromyography: Shows widespread denervation in multiple regions

What is the most likely diagnosis?

(A) Cervical spondylotic myelopathy

(B) Motor neurone disease

(C) Myasthenia gravis

(D) Multiple sclerosis

(E) Syringomyelia