23rd August 2024

You are asked to review a 22-year-old refugee who has recently arrived from Eritrea

You are asked to review a 22-year-old refugee who has recently arrived from Eritrea. On examination, you note that his speech is dysarthric, and he has particular difficulty with repeated syllables. He has increased tone in the lower limbs, along with motor weakness and muscle wasting, particularly distally in movements of the ankle and foot. Reflexes are absent, but his plantars are upgoing. On sensory examination, there is marked loss of vibration and proprioception distally bilaterally, but pain and temperature sensations seem to be mostly preserved. On inspection of his feet, you note, bilateral pes cavus and hammer toes. His spine is scoliosed.  You note that his gait is ataxic, and Romberg’s sign is positive.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.