Abstract
A man in his mid-30s presented with gradually progressive upper and lower extremity weakness most prominent in his right leg. Clinical examination revealed an upper motor neuron pattern of weakness in the extremities, hyperreflexia, and sustained ankle clonus that had progressed over the preceding 2 years. Muscle bulk was normal with unremarkable sensory examination findings. Magnetic resonance imaging revealed marked atrophy of bilateral motor cortices and symmetric increased T2-weighted signal involving the corticospinal tracts (Figure).
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