A 35-year-old male presents with vertigo, unsteady gait, and incoordination. He admits to heavy alcohol consumption over many years. On examination, there is a loss of vibration and position sensation in the lower limbs. What is the most likely diagnosis, and what is the next step?
This patient's history of long-term heavy alcohol use, coupled with his symptoms and examination findings, suggest a diagnosis of alcoholic cerebellar degeneration. This condition can cause gait ataxia, limb incoordination, and loss of position and vibration sense. The next step is to confirm the diagnosis with neuroimaging, typically an MRI of the brain, and initiate treatment, which would include alcohol cessation and rehabilitation therapy.