ABSTRACT
CASE PRESENTATION A 68-year-old retired nursing professor presented to the Columbia University Movement Disorder clinic with a 1-year history of progressive extremity weakness and gait disorder. Her initial symptoms were low back pain, left leg weakness causing her to trip occasionally, and gait incoordination. An outpatient evaluation conducted at a medical center near her home led to the diagnosis of ataxia. Brain magnetic resonance imaging (MRI) and lumbar puncture were normal. Over the next 5 months, there was deterioration in her coordination and progressive bilateral lower extremity weakness, resulting in difficulty arising from a chair or bed. An exaggerated startle response and jerks of her trunk and limbs began and she started falling.
