MRCP2-3007

MRCP2-3007

A 75-year-old man has come to the clinic with his daughter who is worried about his increasing confusion and forgetfulness in the past few months. The daughter also reports that her previously independent father now needs more assistance with daily activities, has lost his appetite, and experiences frequent falls. He has never smoked or consumed alcohol.

The patient’s MMSE score is 20/30. During the neurological examination of his lower limbs, there is increased tone bilaterally, 3 out of 5 (MRC scale) global weakness, lack of sensation to light touch and vibration up to the knees, brisk knee-jerks, and loss of ankle jerk reflexes and extensor plantar reflexes.

The patient’s Hb level is 110 g/L (normal range for males: 135-180), and MCV is 110 fL (normal range: 80-100). Nerve conduction studies show normal conduction velocity but reduced amplitude.

What is the most probable diagnosis?