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A 57-year-old man presented with 6 months’ history of gradual-onset painless fatigable proximal weakness, described as difficulty going up and down the stairs, as well getting out of low chairs. This was unaccompanied by neck/back pain, and sensory, bulbar or respiratory complaints. His constitutional symptoms were significant for fatigue unaccompanied by sleep or mood disturbances, postural lightheadedness, dry mouth and 50 lb unintentional weight loss. Clinical examination showed orthostatic hypotension, mild bilateral hip flexor weakness and generalised hyporeflexia–areflexia, which improved with brief exercise (video 1). Laboratory tests done at an outside hospital showed normal creatine kinase (CK) and thyroid hormone levels.
The differential diagnosis for a pure motor disorder without cranial nerve or sphincter involvement, neck or back …
Contributors WW contributed to the conception of the work, data collection, data analysis and interpretation, and drafting the article. RT contributed to the critical revision of the article. Both WW and RT contributed to the final version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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