Medicine at a Glance: Core Cases

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Neurology

Case 1: An Elderly Patient Who Has Had a Fall in the Night

CASE

A 73‐year‐old woman presents to A&E because of a fall leading to a scalp laceration that requires suturing. The history is that she fell in the dark while getting up in the night to pass water. The astute attending doctor notices that she is unsteady and walks with a high stepping gait. On examination Romberg's test is positive and she has increased tone in the lower limbs.

QUESTION

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The most likely neuroanatomical basis for her problem is: