ALS amyotrophic lateral sclerosis can be mistaken for lung problems
- related: Pulmonology
- tags: #literature #boards
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The patient most likely has amyotrophic lateral sclerosis on the basis of his weakness, fatigue, dysarthria, and hyperreflexia. Diagnosis is based on a clinical picture supported by electrodiagnostic testing and neuroimaging to exclude other disorders (choice D is correct). Amyotrophic lateral sclerosis is a neurodegenerative disease typically affecting male patients twice as common as female patients, with onset typically in the fifth or sixth decade for the nongenetic form. The hallmark clinical manifestation is a combined upper and lower motor neuron dysfunction. Limb weakness is the most common presenting symptom (72%), and muscle fasciculations occur at some point in the disease in about half. Impaired swallowing is common in these patients and parallels the dysarthric speech. His cough and recurrent pneumonias are likely related to aspiration of oropharyngeal material. Progression to respiratory failure is common, with surveys suggesting a median time from diagnosis to referral for noninvasive mechanical ventiolation of just 3 months.1
