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:
Multiple Sclerosis
Amyotrophic lateral sclerosis
Subacute combined degeneration
Progressive spinal muscular atrophy
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.