A 26-year-old right-handed man presented with progressive gait imbalance over the last 6 years. He was in his usual state of health until his junior year of college. He noticed having trouble with his balance while playing intramural sports. When he was a senior in college, he started noticing intermittent difficulty with his balance while standing or walking, especially when walking a straight line. He felt jerky and had intermittent shaking of his legs. He also complained of worsening instability in the dark. He had numerous falls over the last 1 year. Over the months prior to presentation, he started to notice tremors and mild incoordination.Tremors were worse at the end of tasks, especially while eating or drinking. He also complained of mild slurring of his speech. He denied any weakness, numbness, tingling, drooping of the eyelids, double vision, bowel or bladder incontinence, and trouble swallowing.His medical history was otherwise unremarkable for any known contributing factors. He reported no travel history, history of developmental delay, or toxin exposure. He was taking sertraline, multivitamins, and coenzyme Q10. He drank approximately 15 to 20 beers per week and endorsed binge drinking during college years, but he denied tobacco or other illicit drug use. His maternal side of the family was of Irish descent and paternal side, French-Canadian descent. There was no consanguinity between his parents and no known history of neurological disease in his family, and he had 3 siblings who were asymptomatic.His general and mental status examinations were normal. Cranial nerves were normal, other than mild dysarthria. Motor examination showed normal tone, bulk, and strength. He was hyperreflexic in his arms and legs, with bilateral Hoffman sign and clonus at the ankles. Plantar reflex and sensory examination were normal. He had kinetic tremors with end point worsening. Gait examination was normal. Mild dystonic posturing of the right upper extremity was noticed while walking.