Approach to weakness (focal and generalized) Quiz: Ace Your Exams
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A 58-year-old man presents to a neurology clinic for evaluation of progressive weakness. The patient has noticed right-hand weakness for the past 6 months, along with left foot drop, slurred speech, and recent episodes of choking while eating. Medical history is noncontributory, and no daily medications are used. Temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 12/min, and blood pressure is 122/80 mmHg. On examination, there is evidence of muscle atrophy, spasticity, fasciculations, and hyperreflexia. Sensation is intact. Electromyography (EMG) shows evidence of acute and chronic denervation with reinnervation, and a nerve conduction study shows normal sensory nerve action potentials. Magnetic resonance imaging (MRI) of the brain is also normal. Which of the following additional historical findings is most likely to be present in this patient?
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