Paul's Paroxysmal Pains

Paul, a 34-year-old man, first noticed a tingling sensation in his feet, and then developed severe, stabbing paroxysmal pains in his legs. Within months, his walking became unsteady, particularly in the dark. Although his walking was better in the light, even then he avoided falling only by watching the ground.

On examination, his muscles were hypotonic while their bulk and strength were normal. Reflexes in the arms were normal, but the knee and ankle jerks were absent. The plantar reflexes were flexor. Joint position sense and vibration were absent in the legs and normal in the arms. He felt no pain when his Achilles tendons were squeezed, but superficial pain and temperature sense were normal. His gait was wide-based, high-stepping, foot-slapping, and unsteady. He staggered and swayed from side to side as he walked, and could not stand with his eyes closed.

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