cerebral ischemia

A 78yr male, known case of Diabetes Mellitus type 2, on insulin and oral hypoglycemic drugs. Also diagnosed with Parkinson's disease on the list of medications as mentioned below complains of weakness in bilateral lower limb with inability to walk but with support. What could be the cause? some doctors pertain it to prolonged use of insulin. How far is it true?

73y/M difficultly in walking Burning sensation in both foot Weakness while walking

a 38 year old Male patient came to psychiatry opd with wife and brother ( informants - reliable and adequate) with complaints of giddiness, headache, tingling sensation and numbness in bilateral limbs with coarse tremors, disturbances in gait ( wide base gait with stamping of the feets) , visual disturbances ( both short and distant vision with blurring) wife reports low mood, decreased interaction and irritability. forementioned complaints present for past 5-6 months. The patient is a also a known alcoholic with consumption from last 5-6 years. Has h/o consumption of both English and country liquor ( desi, hath bhatti) ranging from two and half to three quarters with h/o binge drinking for 6 month. There have short intervals of abstinence with patient having tremors and headache. however the patient has been abstinent for past 4-5 months owing to above mentioned complaints that were gradually progressive. The patient has H/o head trauma 6 months backs falling roadside with H/o severe bleeding, patient was intoxicated then no Loss of consciousness, ENT bleed, seizures. the patient's major complaint is visual and gait disturbances with coarse tremors. with mood disturbances and irritability. provisional diagnosis with Differentials investigations treatment.

New Case 72 yr M,Known DM 21 yrs,present FBs118mg/ ,HbA1c 6.8,presented with neck pain for 4 yrs aggravated since 4 months.Neck pain radiating to both side of neck to the occipital larea and both upper limbs Rt > left. Intermittent severe pain and at times he had difficulty in taking his food due to severe rt upper limb pain .Pain is shooting in character radiating down on either side up to RT thumb and left wrist.No difficulty in walking. On exam dulling of sensation C2 , 3,4 5 6 ,7 rt side and c56 on the left side.No long tract signs. What abnormality in the MRI?

Pt. Feels tingling and numbness in rt. Side of whole leg later on it also feel on rt. Side of upper limb *Chief Complaints* Tingling sensation and numbness in both right side of upper and lower limb *Investigations* NAD