A 60-year-old male presents with a history of weakness of
his upper limbs.
On examination you note that there is wasting and
weakness of the small muscles of his hands and the forearm muscles. You note
fasiculations. There is weakness. The reflexes are exaggerated.
In the lower limbs there is no wasting or fasiculation,
there is mild weakness, the reflexes are exaggerated, there is ankle clonus
and the plantars are upgoing.
There is no sensory loss.
The likely diagnosis is:
Subacute combined degeneration of the cord
Motor neurone disease