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. Your exam reveals bilateral leg weakness, with absent ankle reflexes, decreased tone in legs. He feels paresthesias running down the back of both legs, and didn't notice you sticking him with a pin until you got to the mid-thigh. Pressure on the lumbar spine causes pain, and he has paralumbar spasm. A 35 year-old black male is seen in clinic with 3 month history of weakness and muscle cramps, first felt in the left arm but progressing to both legs.