One arm hung limply and she walked unsteadily. She had a past history of rheumatic heart disease and took no meds except for birth control pills. 68 year-old white female presents with CC of inability to walk. Upon further questioning you find that this has progressed over a month or two and is not associated with back pain. On exam she is slightly inattentive and sometimes inappropriate.
Language is intact.
She has no CN deficits, and good strength of the UE's. Reflexes are brisk in the legs and she has bilateral Babinski's. Examination reveals an alert woman with normal mental status, decreased LT, PP, Vibration over the night arm and leg. Strength is objectively normal. Your friend, who is a body builder, complains of sudden back pain and the inability to walk.