Motor Neuron Disease

 

Thank you for asking me who presented with difficulty walking / difficulty speaking / difficulty using their hands.

 

My most salient findings were weakness with both upper and lower motor neuron signs, which is suggestive of a diagnosis of motor neurone disease.

 

On general inspection, Harry was comfortable with nil apparent gait aids. 

Harry had dysarthria with a nasal quality speech. The was a wasted, flaccid tongue with prominent fasciculations. There was palatal paralysis. Jaw jerk was increased. Eye movements with normal.

 

On examination of the upper limbs, there was proximal and distal wasting with prominent fasciculations. There was wasting of the small muscles of the hands.

 

There was hypertonia.

 

There was symmetrical weakness in the arms.

 

There was hyperreflexia.

 

Coordination was normal.

 

Sensation was normal.

 

On examination of the lower limbs, there was also proximal and distal wasting with prominent fasciculations.

 

Similarly there was hypertonia, and hyperreflexia with ankle clonus and bilateral upgoing plantars. There was symmetrical weakness. Sensation was again normal.

 

In summary, there was weakness with a combination of upper and lower motor neuron signs with no sensory involvement, which is consistent with a diagnosis of motor neurone disease.