represents the case of a 58-year-old man with a 4-year history of loss of sensation and proprioception and pain in both feet that progressed to include legs and hip regions as well as bilateral leg weakness. By admission he had developed urinary retention requiring catheterization and bowel retention requiring manual evacuation. On examination he demonstrated 2/5 strength in his lower extremities and 5/5 in the upper extremities. He was wheelchair bound, had a T12 sensory level, and had loss of deep tendon responses in the lower extremities.