A 57-Year-Old Man With Unexplained Difficulty Walking

Heidi Moawad, MD

Disclosures

August 23, 2018

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a Case Challenge, please contact us.

Background

A 57-year-old man presents with 4 days of difficulty walking due to clumsiness of both of his feet. He explains that he bumps into the steps as he is walking and that he needs to hold onto the handrail on the staircase for balance when walking up or down the stairs in his house. He also has had intermittent numbness and tingling in his feet, left leg, and hands for about 3 months. He has not had any recent fevers, signs of infection, or injuries. He has no visual changes or cognitive symptoms.

His past medical history is significant for well-controlled hypertension and seasonal allergies. Over the past 10 years, he occasionally had a sensation of numbness and tingling of his hands and feet, without any particular pattern or preceding event. These episodes have resolved on their own.

He reports an infection 4 years ago, from which he feels he never fully recovered. He visited the emergency room at that time for a fever, productive cough, and wheezing. He was diagnosed with a respiratory virus and sent home. During that illness and for about 1 month afterward, he felt that his walking was clumsy, as it is now. His respiratory infection improved and his gait returned to normal. However, he occasionally rides his bicycle for exercise, and after the illness of 4 years ago, he noticed that he was unable to maintain the same level of control on unpaved roads as he had prior to the illness.

He has a family history of hypertension and stroke in his mother and rheumatoid arthritis in his father.

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