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Question category: Neurology

A 69 year old female presents with arm weakness, left worse than right. She has also had some difficulty walking. She has had trouble intermittently with neck pain for many years. On examination there is evidence of 4/5 power in the left arm with evidence of wasting. There is loss of the supinator, biceps and triceps reflex. There is evidence of a spastic gait, increased tone, hyperreflexia and upgoing plantars. What is the most likely diagnosis?

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