Approach to differentiating lesions (spinal cord) Quiz: Ace Your Exams

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A 66-year-old woman presents to the primary care clinic for evaluation of numbness. There has been persistent numbness in all four extremities for the past two months, along with difficulty rising from a chair. Medical history is notable for hypertension, managed with lisinopril. There is no recent history of trauma, vaccination, or infection. Her temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 15/min, and blood pressure is 130/85 mmHg. The patient appears alert. Cranial nerve examination is normal. Vibration sense is impaired in all four extremities, but pain and temperature sensation are intact. Muscle strength is decreased in the distal lower extremities. Gait is wide-based and unsteady, particularly with the eyes closed. Which of the following additional historical findings is most likely to be present?

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Remote untreated syphilis infection

Family history of similar symptoms

A strict vegan diet

Aortic disease

History of optic neuritis