27th July 2023

A 66 year old man with a background of alcohol excess is admitted with bilateral ankle oedema and worsening breathlessness.

A 66 year old man with a background of alcohol excess is admitted with bilateral ankle oedema and worsening breathlessness. He does not have a history of heart failure. He also reports that he has been feeling fatigued, drowsy and has been having trouble concentrating on daily tasks for the past 8 months. Recently, he has also noted that he has experienced tingling sensations down both arms and legs. On examination, you notice him walking with a steppage gait, and his tendon reflexes are depressed.

What is the most likely diagnosis?

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