AANEM Connect

Good morning to all. I will try to present a case as summarized as possible. An 81-year-old woman presented with progressive loss of muscle strength in her left hand, ascending to the shoulder, a clinical condition that began 7 months ago. muscle weakness has compromised the left lower limb to a lesser extent. She has a history of severe left trigeminal neuralgia a few months earlier, which required several interventions, including infiltrations. In June of last year she had an electromyography with a possible diagnosis of C8, T1 radiculopathy. Clinical doctors have dismissed the electromyographic findings, whether due to images of the cervical spine without signs of disc pathology that explains the compression of the lower cervical roots, presence of old infarction in the territory of the left PICA and in brain MRI with small vessel disease Fazekas 2-3. They manage it as sequelae of cerebrovascular disease. an orthopedist requests the examination again. physical examination with signs of upper and lower motor neuron in the left hemibody, the motor conductions of the left median and ulnar nerves are absent, no further striking alterations are evident in the motor and sensory conductions. The study with a monopolar needle shows signs of denervation in the left first interosseous and abductor pollicis brevis, and in the left tibialis anterior with neuropathic units. What do you think, dear colleagues? Do you think it's ALS vs MNN? . What other diagnostic option could I have?
I appreciate the attention provided