65 yrs old man with dysarthria

A 65-year-old man presents with a 4-month history of dysarthria and progressive difficulty in swallowing. Examination reveals a weak fasciculating tongue, a brisk gag reflex, and jaw jerk. 

What is the most likely diagnosis?

A.  Basilar artery thrombosis 

B.  Multiple sclerosis 

C.  Miller Fisher syndrome 

D.  Amyotrophic lateral sclerosis 

E.  Wernicke's encephalopathy



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