Case Study presented by Andrea Brown and Pam Miller

Patient History:

Mr. Wal Kenbad is a 32 year old right handed male who presented with a progressive gait disorder. Three years ago, the patient first noticed difficulty walking in a straight line but did not think much of the problem. Over the next two years, however, this difficulty progressed to the point where he could no longer deny it. By this time, his gait was unsteady and "drunken", causing him to trip frequently especially when turning. He noted marked difficulty negotiating stairs, especially when walking down. At night, in the dark, his unsteadiness worsened. He was diagnosed with a peripheral neuropathy by another neurologist and sent to our center for further investigation and treatment. The patient denied any muscle wasting, weakness, fasciculations, muscle stiffness, tingling, numbness, visual disturbance, dysarthria, dysphagia, diplopia, incontinence, or memory disturbance. He is able to walk up to three miles a day, but his less fatigue easily.

Past Medical History: Unremarkable

Past Surgical History: None

Allergies: NKDA

Medications: Tylenol, as needed

Social History: Unmarried tire salesman with no history of alcohol, tobacco, or drug abuse. He denied any HIV risk.

Family History: No neurological disorders; specifically, no gait abnormalities.

Questions to Ponder:

Is this an upper or lower motor neuron disorder?

What could cause Mr. Kenbad's gait to be "drunken" and unsteady?

What could be responsible for his difficulty negotiating stairs, especially when walking down?

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