Rick, a 55-year-old man, presents with a two-month history of increasing difficulty walking and altered sensation in his legs, with associated low back pain.

He describes needle-like sensations and burning in his feet, difficulty voiding and a tendency to fall.

Rick discloses his difficult life. An industrial accident left him with PTSD, and his history also includes depression, an MI, hypercholesterolaemia and obesity.

He abstains from alcohol because of past abuse and is a non-smoker. He likes to keep to himself and mostly eats takeaway. His only medications are ezetimibe and mirtazapine.