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The patient is a 45-year-old man with a 1-year history of progressive left distal arm and proximal leg weakness. He has gradually developed wasting of his left hand and weakness in holding and grasping. He has also noticed difficulty walking upstairs, and he sometimes chokes on solid foods. He denied ptosis, dysarthria, or any weakness in the right side of his body but reports a mild loss of sensation in the left digits 4 and 5. He was admitted to the hospital with chest pain 2 weeks before examination and had a normal cardiac work-up. An MRI of the brain was normal. A recent laboratory work-up revealed elevated creatine kinase (CK), anemia, and the presence of an immunoglobulin G (IgG) monoclonal spike on immunofixation. Currently, the pat…