01473nam a2200277   4500001000800000005001700008007000300025008004100028040000800069041000800077100004000085245002000125300002100145520067600166650003600842650001700878650002600895650002200921650001400943700003100957700002400988700002501012773011001037942003101147999001701178ESSALUD20260804124912.0ta      t        pe ||||| |||| 00| 0 spa d  aBMG  aeng  aSingh Bajwa, Jasdeep eAutor953676  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 GENERAL953666  aNEUROLOGÍA  aNEUROCIRUGÍA 97782  aORTOPEDIA 925652  aCIRUGÍA  aDhaliwal, Gurpreet 953677  aManesh, Reza953678  aRao, Sandesh 9536790 022717922634dMassachusetts NEJM GroupoNEJM001tThe New England Journal of Medicine wESSALUDx0028-4793  cARTICULOSe2026-07-31zsqb  c22726d22726