b'Coordination: Smooth finger-nose-fingerPertinent labs: movements bilaterally with intact rapidCBC: unremarkablealternating movementsStance and gait: No Romberg sign is present.CMP: unremarkableNormal gait with intact heel, tiptoe and tandemUDS: negativewalking Etoh: 10Reflexes: Biceps, triceps, quadriceps and achillesAcetaminophen: 10reflexes 2+ and symmetric bilaterally. Toes areAmmonia: 43down-going bilaterally Pertinent Imaging:MRI brain without contrast: normal What test will make the diagnosis? What is the final diagnosis?see conclusion on page 24PACEP Has A Store!Get the latest in PACEP gearJackets and Vests embroidered with the PACEP Logo. Personalization is also available.VISIT STOREWinter 2026 19'