Lateral Sclerosis

CASE NUMBER 1. Mr. M. W., a 41-year old white male was admitted to the Victoria General Hospital with complaints of twitching in the left arm and legs, and weakness of the left hand. Seven to eight years prior to admission, the patient noticed dull muscle pain in his arms and legs, lasting four to five days at a time. The pain worsened as the day passed and was neither aggravated nor relieved by anything the patient did. The remissions lasted up to three months. The patient had no episodes of pain in the three years preceding the onset of the present sumptoms Six months prior to admissions, he noticed weakness in his left hand which gradually worsened. And, two months after the onset of this symptom, he noticed twitching of the muscles of his left arm and right leg, and to a lesser extent, the muscles of the other two limbs. He developed unsteadiness due to weakness in his right leg. On admission, he complained of cramps in his right calf and left hand. His past, family, and personal histories were non-contributory. On physical examination, the only abnormalities were neurological. Cerebral and cerebellar functions were normal. No cranial abnormalities were detected. Muscle power was markedly decreased in the left hand and wrist and moderately decreased in the left elbow. There was weakness of the right ankle extensors, right hip flexors, and the right knee flexors. There was noticeable wasting in the thenar and hypothenar eminences and on the dorsum of the left hand. Muscle tone was normal. Reflexes were generally hyperactive, especially those of the left arm, left leg, and right leg. Hoffman's sign was absent. Plantar and abdominal reflexes were normal. Sustained ankle clonus was present bilaterally. Gross fasciculations were present in the legs,