A 58-year-old male presents with a history of falls and
difficulty in performing common tasks like opening doors.
He also gives a history of choking when he eats.
The history is of several months duration and he feels
the problems are steadily getting worse
There is no other significant history, no family history
of note and he is not on any regular medication.
On examination you note weakness of the muscles of his
shoulder and pelvic girdle and distal weakness, especially affecting the
There is asymmetric wasting of the muscles. Tendon
reflexes are preserved.
There is no sensory deficit.
In this patient the most likely diagnosis is:
Inclusion body myositis
Amyotrophic lateral sclerosis