The family has noticed a change in her voice. There are no bowel or bladder complaints. Patient denies any history of diabetes mellitus, heart disease, infections, recent travel outside the US, lung disease, cancer. Patient has a history of hypertension. No significant surgical history.
Patient denies smoking or alcohol abuse.
She had a very unsteady gait due to weakness in the legs. Propioception, vibratory sensation and light touch were intact throughout. The patient had a left XI and XIIth nerve paresis. In addition, flexion of the neck elicited a painful sensation down the back. Otherwise, the exam was unremarkable.