Condition On Admission

The patient’s chief complaint was of weakness in all four limbs for more than 20 years. Patient first noted he had a weakness in both his upper limbs in 1987, which was especially evident in his handwriting. The weakness progressively got worse over time. In 1994, he noticed he had problems walking up and down stairs and would trip over himself from time to time; an MRI confirmed a diagnosis of Ataxia. On physical assessment upon hospital admission he was found to have low muscle tone in all limbs with muscle power of 5/5. Coordination tests such as finger-to-nose and heel-to-tibia showed poor coordination and the patient was unable to walk heel-to-toe. Routine examination showed no other abnormalities.