ABSTRACT
CASE PRESENTATION A 50-year-old previously healthy man was seen for the first time in December 2004 for decreased motor skills as well as problems with bowel and bladder. He first noticed that his gait was ‘a little unstable’ in 2002. About the same time he noticed erectile dysfunction and a change in his voice: hoarsaess He was seen by an otolaryngologist and had a reportedly normal laryngoscopy. Under a neurologist ’ s care he underwent an MRI scan of the head and neck, reportedly normal, as were evoked potentials. Within one year, he developed constipation, alternating with large bowel movements followed by ‘almost uncontrollable diarrhea, ’ with rare fecal incontinence. Concurrently, he experienced urinary urgency, frequency, occasional incontinence and enuresis as well as occasional lightheadedness, especially on a second flight of stairs.
