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Case 23 

Case 23
Chapter:
Case 23
Author(s):

Harutomo Hasegawa

, Matthew Crocker

, and Pawan Singh Minhas

DOI:
10.1093/med/9780199599837.003.0023
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date: 22 August 2019

A 60-year-old man presented with a 2-month history of progressive unsteadiness. He reported having a painful sensation over the previous 18 months which began in the feet and gradually ascended in the legs. Intermittently, he also found it difficult to pass urine. His medical history was unremarkable and he was not on regular medication. On examination, he was alert and orientated. In the lower limbs, the tone was increased, power was normal, and reflexes were brisk. Proprioception was impaired bilaterally in the toes and plantars were upgoing bilaterally. Romberg's test was negative and there were no cerebellar signs. A sensory level was identified at the level of T3. The upper limbs were normal.

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