Neurology
CASE 13: A WEAK HAND
History
A 67-year-old man is referred to a neurologist by his general practitioner (GP). His symp-
toms 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. His speech is slightly slurred and he has started
choking after taking fluids. Past medical history is notable for hypertension for 15 years
and a 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 to be found in the cardiovas-
cular or respiratory systems or the abdomen. There is some wasting of the muscles in the
upper limbs, particularly in the left hand. There is some fasciculation in the muscles of the
upper arms bilaterally. Power is globally reduced in the left hand, and also slightly
reduced in the right hand. Muscle tone is normal. The biceps and triceps jerks are brisk
bilaterally. There is no sensory loss. There is slight dysarthria.
Questions
- What is the diagnosis?
- What is the prognosis?