Which of the following clinical cases would include the ALS in the differential diagnosis?

Correct answer is D. Symptoms Specific for ALS: Patient: A 50-year-old man. Complaint: Progressive weakness and muscle atrophy. Additional Information: Difficulty swallowing (dysphagia), difficulty speaking (dysarthria), fasciculations (muscle twitches), hyperreflexia and spasticity. Possible Diagnosis: Amyotrophic lateral sclerosis (ALS), a neurodegenerative disease affecting motor neurons in the brain and spinal cord.