But Now I'm Sober!

A 37-year-old alcoholic man complained of unsteadiness. This had been a problem for 2 or 3 years and was getting progressively worse. It had begun to interfere with his drinking: he had difficulty walking from his rooming house to the package store, and, once there, he was often refused service because he had a drunken walk even when sober. In addition, he complained of both numbness and burning in his feet.
 

On examination he was poorly nourished but awake and alert with normal speech and mentation. His cranial nerves were normal and there was no nystagmus. His muscle strength and tone were also normal. While coordination was normal in the arms, the heel-to-knee-to-shin test was done poorly. The ankle jerks were absent but the other tendon reflexes were normal and the plantar reflexes were flexor. There was a stocking type sensory loss to pin prick bilaterally to just above the ankles. Sensation was otherwise intact. The stance and gait were wide-based and reeling. Romberg's test was negative.

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