Extraocular movements reveal impaired conjugate gaze to either side with occasional slight tendency for upbeat nystagmus. Coordination is significant for marked ataxia in the upper extremities with intention tremor being very prominent. She has only mild titubation at present. In the lower extremities the patient has a paraparesis with the right lower extremity more affected than the left. Deep tendon reflexes are brisk throughout with bilateral extensor toe signs.
Sensory exam reveals distal loss of vibratory sense in all four extremities which is mild.
Pin prick is intact. No sensory level is detected on the abdomen or thorax.