{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:54:09Z","timestamp":1777877649299,"version":"3.51.4"},"reference-count":15,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Neurohospitalist"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>Subacute-to-chronic gait instability has a broad differential diagnosis. The neurological exam can help elucidate the localization and suggest an underlying etiology of the symptomatology, which can lead to a more focused diagnostic approach. Two patients are described \u2013 1 with a month of worsening difficulty with ambulation that evolved to bilateral hand discoordination and another with 18\u00a0months of progressive difficulty with ambulation that also then progressed to involve her bilateral hands. These cases highlight an approach to gait dysfunction with hand discoordination secondary to sensory ataxia. The patients were ultimately diagnosed with copper deficiency myelopathy secondary to zinc excess, and different treatment regimens are discussed.<\/jats:p>","DOI":"10.1177\/19418744251314210","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T14:27:59Z","timestamp":1736519279000},"page":"286-290","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Problem Solving: Two Patients With Gait Instability and Difficulty With Hand Coordination"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8626-7587","authenticated-orcid":false,"given":"Trevor","family":"Glenn","sequence":"first","affiliation":[{"name":"Mass General Brigham Neurology, Brigham &amp; Women\u2019s Hospital and Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amine","family":"Awad","sequence":"additional","affiliation":[{"name":"Mass General Brigham Neurology, Brigham &amp; Women\u2019s Hospital and Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Galina","family":"Gheihman","sequence":"additional","affiliation":[{"name":"Instructor in Neurology, Harvard Medical School and Attending Physician, General Neurology, Brigham &amp; Women\u2019s Hospital and Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7406-307X","authenticated-orcid":false,"given":"Alexis","family":"Roy","sequence":"additional","affiliation":[{"name":"Instructor in Neurology, Harvard Medical School and Attending Physician, Stroke Division, Brigham &amp; Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,1,10]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.sult.2023.03.015"},{"issue":"10","key":"e_1_3_4_3_2","first-page":"954","article-title":"[Isolated posterior cord syndrome in Lyme s disease: a clinico neurophysiological study]","volume":"33","author":"Guti\u00e9rrez MA","year":"2001","unstructured":"Guti\u00e9rrez MA, de Pablos C, Oterino A, Garc\u00eda Monc\u00f3 JC. 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