19th February 2024

A 54-year-old male with known significant alcohol use presents with pins and needles sensation along his legs bilaterally.

A 54-year-old male with known significant alcohol use presents with pins and needles sensation along his legs bilaterally. He describes mild weakness with ankle dorsiflexion and plantarflexion bilaterally. He has reduced fine touch, proprioception and vibration sensation along a glove and stocking distribution. He has a positive Rhomberg’s sign on standing. He has absent ankle reflexes but has upgoing plantars and clonus along both ankles. The increased tone is noted throughout. 

Given the likely diagnosis, which of the following areas has likely been affected?