Question category: Neurology
A 58 year old gentleman presents with weakness in his hands. He states that he has noticed his hands feeling weak and has difficulty opening his hands after he makes a fist or shakes a persons hand. He has also noticed his eyelids drooping and difficulty chewing. He is also complaining of weakness in his legs. On examination there is evidence of early frontal balding and wasting of the temporalis muscle. He has facial weakness and a mask like appearance. There is evidence of reduced power in his hands and the distal muscles of his legs. Sensation is normal.