Will's Worsening Weakness

Will, a 40-year-old man, had been ill for over a year. He first noted weakness in his right hand. After 3 or 4 months, the muscles of that hand withered, and his left hand began to weaken in turn. Within a year, he had trouble walking, his legs were weak, and his leg muscles were asymmetrically wasted (right more than left). Eventually, he was forced to remain in bed because he could not walk.

Examination revealed weakness in all 4 limbs, especially in the hands. The muscles were atrophied, and fasiculations were present in both arms and the right leg. The legs were stiff. Deep tendon reflexes were absent in the arms and hyperactive in the legs. Abdominal reflexes were absent bilaterally, and there were bilateral Babinski signs. Sensation was normal.

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