Clinical Reasoning: A 62-Year-Old Woman With Progressive Spasticity, Weakness, and Gait Instability

Evaluating patients with adult-onset gait instability can pose diagnostic challenges. In this case, a 62-year-old Ashkenazi Jewish woman with a history of surgically corrected hammer toes presented with chronic progressive lower extremity weakness, sensory impairment, and gait instability. Subsequently, the patient developed urinary urgency and mild cognitive difficulties. This case underscores the approach to diagnosing patients with gait difficulty by constructing a comprehensive differential diagnosis focusing on the neurologic localization of this case and exploring probable etiologies. Readers will deepen their comprehension of this neurologic process and its differential diagnoses to ultimately arrive at a final diagnosis.