26th August 2024

A 48-year-old woman presents to A&E with progressive difficulty with walking

A 48-year-old woman presents to A&E with progressive difficulty with walking. She notes that she often stumbles and catches her feet. On examination, power is 4/5 throughout the lower limb with evidence of mild spasticity, proprioception is impaired bilaterally, and vibration sensation is poor. Sensory exam is otherwise normal.  An MRI of the spine is performed, which shows mild degenerative disease but no canal or foraminal stenosis. All other investigations are normal, with the exception of a mild anaemia with a raised MCV.

Which treatment would be most appropriate?

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