Muscle Fasciculations on Physical Exam

81 year old patient. History of swallowing disorders, weight loss and muscle weakness of 5 months evolution. Lower motor neuron disease is suspected due to the finding of muscular atrophy and fasciculations on physical examination.

Most healthy people have had fasciculations at some time in their lives, especially at the level of the eyelid muscles. Regarding their clinical importance, if they are not accompanied by other findings, the neurological physical examination is usually benign. However, when observed together with atrophy or muscle weakness, fasciculations indicate lower motor neuron involvement, usually of the anterior medullary horn or the proximal peripheral nerve. The twitching of the tongue occur up to one third of patients with amyotrophic lateral sclerosis.

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