This 65-year-old man presented with a 4-year history of left-leg stiffness and weakness. He complained that his left foot will “slap” when walking. A lumbar laminectomy had not improved his symptoms. Recently, his wife noted his speech was slurred.

This 65-year-old man had a 4-year history of progressive lower extremity weakness and stiffness, and more recently he had slurred speech. Examination was remarkable for spasticity in both legs, a weak left leg, a left Babinski sign, and a spastic gait. He was diagnosed with primary progressive MS.