A 63-year-old retired coal miner complained of left upper extremity burning pain and numbness followed by weakness of both upper extremities. At the time of the video, the patient had difficulty chewing and could not clean his dentures because of impaired hand dexterity. He could not drive because he had inadequate control of the steering wheel. He also could not write due to inability to properly hold a pen.

Our patient had a striking combination of progressive sensory disturbance of the limbs resulting in large fiber sensory dysfunction and subsequent ataxia. In addition, he had involuntary movements of the hands and face consistent with chorea, although it is plausible that some of the hyperkinetic phenomenology may be due to proprioceptive deprivation (“pseudoathetosis”).