01346nam a2200253   4500001000800000005001700008007000300025008004100028040000800069041000800077100003300085245002000118300002100138520067600159650002900835650001700864650002000881650001500901650001400916700002400930700001700954700001800971773010300989ESSALUD20260804124912.0ta      t        pe ||||| |||| 00| 0 spa d  aBMG  aeng  aSingh Bajwa, Jasdeep eAutor  aThe daily grind  apáginas: 54-68  aA 56-year-old woman was admitted to the hospital for gait instability. Eight weeks before presentation, she had noticed a gradual onset of ascending symmetric sensations of painful “pins and needles” that had begun in her feet. Two weeks before presentation, she began to have short-term memory impairment, difficulty concentrating, irritability, anorexia, and palpitations, along with paresthesias in her hands that were similar to those that had begun in her feet. She was unable to feel her feet on the ground when she walked, which led to frequent stumbling, and she braced herself against walls for stability. She reported no headaches, weakness, or weight loss.  aMEDICINA CLINICA GENERAL  aNEUROLOGÍA  aNEUROCIRUGÍA   aORTOPEDIA   aCIRUGÍA  aDhaliwal, Gurpreet   aManesh, Reza  aRao, Sandesh 0 022717dMassachusetts NEJM GroupoNEJM001tThe New England Journal of Medicine wESSALUDx0028-4793