Hello
I would like to hear some sugestions regarding investigation in this patient.
65 yo male, with long standing distal paresis in 4 limbs, almost with bilateral dropped foot. Wife says he allways walked funny, and she knows him since teenage. No pain, no atrophy, weak osteotendinous reflexes, distal tetraparesis (3/5) , simmetric, multimodal sensation, even distally, preserved, no cranial nerve involvement.
EMG with normal conduction studies, but with myopathic signs in all muscles studied, no myotonic discharges, no dennervation.
CK with slightly above normal value.
Any sugestions on further investigation or possible diagnosis?
Thanks