A 45-Year-Old Man Comes to the Office for the Evaluation

A 45-year-old man comes to the office for the evaluation of excessive wasting of his extremity muscles, which is more apparent on the extensor side.  The weakness began distally and asymmetrically.  He recently started to have difficulties with swallowing, chewing, and speaking.  He feels some movements in his face and tongue.  He also has muscle stiffness.  His bowel, bladder, cognitive, and sensory functions are intact.  The physical examination reveals excessive wasting of his muscles, which is more prominent in the lower extremities.  Fasciculations and hyperreflexia are noted.  His bulbar reflexes are decreased.  What neural pathway is most likely damaged?

A) Pyramidal tract
B) Lower motor neuron
C) Upper motor neuron
D) Lower and upper motor neuron
E) Cerebral cortex

Correct Answer:

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