A 56 year-old right hand dominant male presented to the emergency department with weakness in his bilateral hands, worse on the left. For the last several months, he had been having daily neck pain and frequent occipital headaches. He had been dropping things more frequently, but noticed over the previous week that he had increasing difficulty getting dressed in the morning. He used to be very active, but began using a walker last year because of frequent falls from what he described as always “feeling off-balance”. He also endorsed intermittent tingling in all fingers of his left hand.