Question: A 77 year old male is referred to you for progressive voice changes including dysphonia and difficulty with articulation in the setting of progressive body weakness and weight loss.  Examination reveals slow, deliberate speech with dysarthria.  Tongue fasciculations are noted.  Laryngoscopy reveals limited abduction of both vocal folds with a central glottic gap on adduction.  What is the most likely diagnosis?

[Answer will be posted with next week's new question]

Answer to last week's question, "Blow Your Nose" (June 4, 2018)

Cocaine