Case Challenge: A Woman with Ataxic Gait and Paresthesias

A 57-year-old woman presented to our neurology clinic with a 4-month history of progressive gait impairment and ascending numbness and tingling of the lower extremities. Her symptoms slowly progressed, and subsequently she noted a cold sensation in both hands, thigh numbness, mild bilateral leg weakness, and a sensation of tightness of the upper abdomen. The patient denied visual changes, incontinence, or constitutional symptoms. Her relatives had not noticed any change in the patient's behavior or cognitive abilities. Gradually, she began to require assistance with activities of daily living. Her medical history was otherwise unremarkable except for long-term gastritis, treated with proton-pump inhibitors. She had no history of surgery, re…