This chapter talks about a 30-year-old man who was referred in 2001 to a neurologist because of memory complaints affecting his ability to perform at work as a cashier in a liquor store. His latest assessment in 01/2010 showed some dysarthria, dragging of his left leg during ambulation, mild face bradykinesia, hyperreflexia of all four limbs, equivocal left plantar response, unsustained clonus of both ankles, and decreased foot tapping bilaterally. There was much hesitation in diagnosing a progressive neurodegenerative condition until 8 years into the symptoms, because of the use of marijuana and the dependant personality. A follow-up is proposed to offer the patient a trial of a cholinesterase inhibitor, considering the finding of a reduced cortical choline-acetyl-transferase (CAT) activity in his mother's autopsy. The objective findings on neuro-imaging allow him to obtain full medical disability for a well-defined neurological condition.

Nontraumatic spinal emergencies can be caused by a wide spectrum of conditions including infection, hemorrhage, and neoplasm. The most common findings in patients with spinal emergencies are pain, motor deficits, sensory deficits, abnormal reflexes, and urinary dysfunction. Acute back pain is the only symptom of catastrophic spinal emergencies such as spinal hemorrhage or infection. Sudden paralysis can result from trauma, cord infarction, or hemorrhage. Even though a thorough sensory examination in the emergency department is often difficult and unreliable, complexes of sensory and motor abnormalities are helpful. As a result of the anatomical distribution of upper and lower motor neurons, acute spinal cord lesions almost always present with hyperreflexia. The mechanism of urinary incontinence depends on the type of lesion. Spinal cord emergencies frequently go unrecognized initially or are misdiagnosed even with such obvious symptoms as the inability to walk or bladder function failure.