What is the most likely diagnosis in this patient who was having difficulty swallowing?
Amyloidosis
Amyotrophic lateral sclerosis
Pellagra
Pernicious anemia
Answer B. Amyotrophic lateral sclerosisWith his difficulty swallowing, the patient's tongue atrophy represents a bulbar symptom, and is most consistent with a diagnosis of amyotrophic lateral sclerosis (ALS). The patient also had clinical and neurophysiological evidence of upper-motor-neuron and lower-motor-neuron involvement, which supported the diagnosis. ALS is associated with dysarthria, hypophonia, dysphagia, and sialorrhea in addition to relentlessly progressive disability.
Miscellaneous