ABSTRACT
CASE PRESENTATION A 66-year-old man presented with the gradual onset of a ‘left hand cramp’ and progressive inability to use the left hand. The patient described a loss of dexterity most apparent when using a key or buttoning with the left hand. He also complained of stiffness and irregular jerking confined to the left upper extremity. Over the next year, he developed numbness in the left hand, an unsteady gait, and the gradual onset of stiffness in the right upper extremity.
