At present there is a negative history for tobacco use for the past 30 years and he drinks about 12 beers per week. If necessary, revise your differential diagnosis based on the additional clinical history. Expand comments beyond the basic answers. The patient is alert, oriented, and in no acute distress. Cranial nerves 2-12 are found to be intact.
Pupils are symmetrically round and reactive to light.
No eyelid ptosis is noted and extraocular movements are full. Muscles innervated by cranial nerves are not atrophic and no fasciculations are observed in the head, torso, or upper or lower limbs. A mild degree of forearm muscle wasting is observed. There is noted to be a reduction in pinprick and light touch extending from the feet to the mid calf level bilaterally. Sensation in the hands is normal.