A 65-year-old man with increasing difficulty walking

Case presentation

History and examination

A retired 65-year-old man presented to his general practitioner describing difficulty in walking. The problem had been increasing slowly, such that he now needed a walking frame and was not confident to leave home. In recent weeks he had noticed clumsiness when doing up the buttons on his shirt and difficulty in holding a knife and fork. He described more neck stiffness than pain. On questioning, he admitted to urinary urgency over the last few months.