A 58-year-old man presents with progressive hand weakness and muscle cramps over 6 months. Vital signs: BP 128/82, HR 88, RR 16, Temp 37.0°C, SpO2 98%. Examination reveals fasciculations in forearms, spasticity in legs, hyperreflexia, and bilateral upgoing plantar responses. Sensory examination is intact throughout. Serum creatine kinase is mildly elevated at 320 U/L. Electromyography shows denervation patterns in multiple myotomes. Which of the following is the most likely diagnosis?
- A)Spinal muscular atrophy
- B)Amyotrophic lateral sclerosisGABARITO
- C)Multiple sclerosis
- D)Myasthenia gravis
- E)Guillain Barré syndrome
Explicação
The combination of upper motor neuron signs, lower motor neuron signs, and preserved sensation is classic for amyotrophic lateral sclerosis. ALS degenerates corticospinal neurons and anterior horn cells while generally sparing sensory pathways. Ver explicação completa e trilha adaptativa →