A fifty-five year old Somali man came complaining only of dysarthria, progressive for four years. Onset was gradual. When he recited the first Surah of the Quran one could hear a primarily palatal (nasal) dysarthria, some lingual component, but no facial/lip or glottal elements audible. Facility of movement in lips and tongue virtually normal, and no fasciculations seen in tongue, palate or face or body. No snout, suck, or corneal-mandibular reflexes. In the limbs DTRs are 1+ diffusely. Foot strength and expecially facility of movement were impaired but he had no complaint of this. The plantar reflexes were flexor, and sensation normal. EMG in the right arm and leg normal except for 2+ insertional potentials in the flexor carpi ulnaris with a rare fasciculation, and 1+ insertional potentials in the first dorsal interosseus with 2+ polyphasics, findings I attributed to an unrelated ulnar denervation. Right peroneal nerve NCT and F-wave were quite normal. Cholesterol 3.53mmol/L, weight 50kg. Representative MRI slices available at:
This is all the data I have. Nothing being withheld for grand-rounding. What do you think he's got? I DON'T have the answer, only the QUESTION! Speak up neurocitizens!