A Fisherman Who Cannot Peel Shrimp Anymore

A 21-year-old shrimp peeler developed weakness of his fingers five years earlier; it progressed to a degree that he is unable to perform his job. He had no neck pain, arm numbness, dysphagia or muscle twitching. Family history was non-relevant. Examination is shown. CPK was 530 U/L and EMG revealed chronic diffuse denervation of the arms muscles with normal sensory and motor responses. EMG of the legs was normal.

CHALLENGE QUESTION

The most likely diagnosis is:

1. ALS

2. Hirayama disease

3. IBM

4. West Nile virus infection

5. Cervical radiculopathy

Find the answer and diagnosis in the next edition of Practical Neurology or online, posted along with the patient video at PracticalNeurology.com.

Case selected from Dr. Shaibani’s Video Atlas of Neuromuscular Diseases, now available from Oxford University Press.Aziz Shaibani, MD, FACP, FAAN is Director of Nerve & Muscle Center of Texas and Clinical Professor of Medicine at Baylor College of Medicine in Houston, TX. He is also Adjunct Professor of Neurology at Kansas University Medical Center in Kansas City, Kansas.