45 yr old patient presented with difficulty in walking for 7 months and feeling imbalance during walk.he has no h/o headache, vomiting, fever, any visual problem and DM.but he is hypertensive on amlodipine. On examination pulse 78,BP 140/80.higher mental function ,cognitive function, cranials are intact.there is horizontal nystagmus but coordination and speech normal. Other positive findings are high stepping gate, positive romberg,impaired joint position and vibration, exaggerated all 4 limbs jerk,equivocal planter.no tremor.other sensory modalities intact.CT MRI not done.other investigation uneventful.
