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How Good at Neurology are you? – Questions
  1. Paul Goldsmith*,
  2. Graham Lennox*,
  3. Julian Ray
  1. *Departments of Neurology and
  2. Neurophysiology, Addenbrooke’s Hospital, Cambridge, UK. Email; pg255{at}; drslennox{at}; j.l.ray{at}


1. Please read the following passage.

A 65-year-old man, (see Fig. 1), was referred with numb feet. He had first noticed the symptoms over 10 years ago, but had ignored them. The numbness had steadily got worse, and he was now starting to fall over because of poor balance.

He was a heavy smoker with a history of chronic abstructive airway disease and hypertension. A squamous cell carcinoma had been removed from his left arm 3 years previously. He took regular doxazosin, simvastatin, bendrofluazide and aspirin, as well as his inhalers. He was adopted and did not know his family history.

On examination a slight decrease in pinprick and temperature sensation was noted in a glove and stocking distribution. He was areflexic with downgoing plantars.

FBC, Us & Es, Glucose, TSH, B12, folate, ANA, ENA, VDRL, and protein electrophoresis were all normal or negative.

What is the diagnosis ?


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