A middle aged man presents with progressive atrophy & weakness of hand & forearms. On examination he is found to have slight spasticity of the leg, genera-lized hyperreflexia and increased signal in the coico-spinal tracts on T2 weighted MRI. The most likely diagnosis is:: (A) Multiple Sclerosis, (B) Amyotrophic lateral sclerosis, (C) Subacute combined degeneration, (D) Progressive spinal muscular atrophy
Answer is B. B i.e., Amyotrophic Lateral Sclerosis The presence of both lower motor neuron signs (progressive atrophy & weakness of hands) and upper motor neuron signs (spasticity & hyperreflexia) in the patient with increased signals (hyperintensity) of coicospinal tracts on T2WI of MRIQ leads us to the diagnosis of Amyotrophic lateral sclerosis.