Clinical Reasoning: A 28-Year-Old Woman With Vision Loss and an Unusual Gait

A 28-year-old woman with a history of migraine with visual aura and normal growth and development presented with gradually progressive vision loss since the age of 13 years (legally blind since the age of 20 years) and with later development of gait imbalance and falls beginning at the age of 25. Ancestry was Dominican on both sides, and the family history was significant for a father with an onset of tremor, dysarthria, and balance difficulties at the age of 47 and a paternal half-sister with an onset of tremor at the age of 6, both without visual loss. Her 3 brothers and 2 children were healthy.

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