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hi my name is Paul and this is Al Al is 54 years old and has a very interesting diagnosis um a couple of months ago started to develop some unusual paresthesias tingling down the legs some generalized weakness having a hard time getting up out of a seated position also started to notice some urinary and um bladder I bladder and bowel incontinence difficulty with control uh and then becoming incontinent um also had some discomfort and down the leg and also noticed some atrophy docHub atrophy in the left leg so he came to see us and um we assessed him and interestingly enough his he has a little less reflex oh that oneamp;#39;s not too bad heamp;#39;s a little hyper on this side Achilles reflexes are good and equal we do a babinsky on him here we get a little upward going prior to taking steroids this toe was UPG goinging like you see there I donamp;#39;t know if you can see that the big toe is up going toward the end little toes go down thatamp;#39;s okay so thatamp;#39;s a qu
