,PERTINENT HISTORY AND EXAMINATION:,  Briefly, the patient is an 83-year-old woman with a history of progression of dysphagia for the past year, dysarthria, weakness of her right arm, cramps in her legs, and now with progressive weakness in her upper extremities.
,PERTINENT HISTORY AND EXAMINATION : , Briefly , the patient is an 83 - year - old woman with a history of progression of dysphagia for the past year , dysarthria , weakness of her right arm , cramps in her legs , and now with progressive weakness in her upper extremities .