A 57-Year-Old Man With Unexplained Difficulty Walking

Heidi Moawad, MD

Disclosures

August 23, 2018

Physical Examination and Workup

Upon physical examination, the patient is a healthy-appearing male in no acute distress. His skin is normal with no rashes, wounds, bruises, or discoloration. He does not have jaundice of the skin or eyes.

His chest is clear, and his heart sounds are normal. Abdominal examination findings are normal, with no distension, pain, or tenderness. His pedal and radial pulse examination findings are unremarkable.

Upon neurologic examination, no spasms or fasciculations are observed. His cranial nerve examination findings are normal. Upon motor examination, he has decreased strength in both of his arms and legs, described as 4/5, with slightly more pronounced weakness of his left leg. Upon reflex examination, he has diminished reflexes in the right leg and both arms and feet; however, his reflexes are not absent. He has absent vibratory sensation up to his knees in his lower extremities and up to his elbows in his upper extremities. He has decreased touch sensation in his fingers and toes. He has diminished sensation to pinprick in his feet up to his ankles and in his hands, with almost normal pinprick sensation at his wrists and above his wrists. His gait is slightly unsteady. Romberg sign testing is positive.

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