A 22-year-old woman was admitted after sudden onset of leg buckling when she attempted to stand and walk. She was 2 months postpartum. Review of systems was normal. The patient admitted to feeling overwrought with the stressors of a new baby and her engagement to the baby’s father.

Is her gait dysfunction organic in nature? Despite full strength, normal muscle tone, unremarkable muscle stretch reflexes, and normal sensory and cerebellar examination, our patient had a bizarre and rather spectacular gait disorder characterized by exaggerated effort, variability with distraction, excessive slowness or hesitation in walking, and sudden buckling of her knees without falling. Her gait pattern did not resemble a hemiparetic, ataxic, shuffling, steppage, or scissor type of gait abnormality. The sudden-onset, markedly incongruent features, and inconsistent phenotype were consistent with a clinically definite psychogenic ataxia.