ataxia and numbness/tingling

[erinto]

60 yo white female presents to the ED with the complaint of bilateral lower extremity numbness and tingling, and difficulty walking.   She states she has to hold onto the wall in order to walk, and feels off balance.   Symptoms have been gradual, onset in the last few weeks, but worse today.   She cannot walk without the assistance of a cane and holding onto someone or the wall.    She denies falling, fever, chills, injury, any focal deficits, chest pain, SOB, or previous symptoms like this.    The weakness is bilateral lower extremities and equal bilaterally.    She has HTN and varicose veins.    Medications include HCTZ and atenolol.    She is allergic to codeine.   VS are all WNL.   Exam shows mild weakness bilateral lower extremities with hip extension and flexion (4/5 bilaterally and equal), but otherwise normal exam, including cardiac, respiratory, GI, neuro, skin, and orientation.    

What important history am I missing?    Clue-this directed tests which resulted in the diagnosis.   

[jpollock]

any history of a rash? recent spine instrumentation or surgery?

[tyson]

Any history of uri or diarrhea?

Any cerebellum symptoms? Finger to nose and shin test?

[pbruss]

recent flu shot?

[erinto]

All excellent ideas...was actually social history. She admitted to three glasses of red wine per night for more than 20 years. I added folic acid, B12, and ETOH levels. ETOH was 0.09 a full 13 hours after her last drink. She likely was greater than 0.3 nightly. I admitted her, on a banana bag. The levels came back two days later critically low.