Clinical Reasoning: A 47-year-old man with progressive gait disturbance and stiffness in his legs

Abstract

A 47-year-old man presented with a 5-year history of slowly progressive gait disorder with clumsiness and unsteadiness during walking, as well as stiffness and cramping pain in his legs. He also had erectile dysfunction and nocturia. He denied sensory deficits and other focal neurologic or systemic symptoms. He had a medical history of hypogonadism, diagnosed 1 year before the onset of the gait disorder, attributed to a bilateral orchiectomy due to a testicular tumor, performed elsewhere when he was 37. He was receiving IM testosterone injections every 3 weeks. His family medical history included pes cavus in his mother and siblings, otherwise unremarkable.