A 48-year-old male was brought to the emergency department with difficulty breathing for 2 hours. His family reports that the patient has been experiencing slurred speech, difficulty swallowing, arm weakness, and increased muscle twitch over the last two years. There has been no diagnosis established despite multiple neuroimaging workups. His BP was 130/90 mmHg, pulse 116 bpm, RR 28 breath/min. His SpO2 is 85% on room air. Immediate bronchodilators and supplemental oxygen were given to the patient, but the patient, unfortunately, is noted to deteriorate rapidly and suffers respiratory arrest and expires upon admission to the hospital. He has no other significant medical history. His right arm appears atrophic. An autopsy is performed to determine the cause of death, which reveals atrophy of diaphragmatic muscles.