<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 54-year-old man comes to the physician for the evaluation of difficulty swallowing of both solids and liquids for 1 month. During the past 5 months, he has also had increased weakness of his hands and legs. He sails regularly and is unable to hold the ropes as tightly as before. Ten years ago, he was involved in a motor vehicle collision. Examination shows atrophy of the tongue. Muscle strength is decreased in the right upper and lower extremities. There is muscle stiffness in the left lower extremity. Deep tendon reflexes are 1 in the right upper and lower extremities, 3 in the left upper extremity, and 4 in the left lower extremity. Plantar reflex shows an extensor response on the left foot. Sensation to light touch, pinprick, and vibration is intact. Which of the following is the most likely diagnosis?? A: Syringomyelia, B: Amyotrophic lateral sclerosis, C: Inclusion-body myositis, D: Subacute combined degeneration of spinal cord, E: Cervical spondylosis with myelopathyn,  <response>: This is a clinical vignette describing a 54-year-old man with 1 month history of dysphagia to solids and liquids, as well as 5 month history of progressive weakness in his hands and legs. He also has difficulty holding ropes while sailing, indicating hand weakness. On exam, he has tongue atrophy, decreased strength in the right upper and lower extremities, increased muscle tone in the left lower extremity, hyperreflexia in the left upper and lower extremities, and extensor plantar response on the left. Sensation is intact. The key findings are progressive weakness and atrophy in multiple areas, especially the tongue, asymmetric reflexes, and upper motor neuron signs like increased tone, hyperreflexia and extensor plantar response. This indicates an upper motor neuron disease like amyotrophic lateral sclerosis ALS. Syringomyelia would not cause such diffuse findings. Inclusion body myositis causes symmetric proximal weakness. Subacute combined degeneration from vitamin B12 deficiency causes sensory changes. Cervical spondylosis causes sensory changes and symmetric signs.B: Amyotrophic lateral sclerosis 