A 20-year-old male presents with progressive weakness in his legs and balance problems. His father had similar symptoms starting in his 20s. On examination, there is loss of vibration and position sensation in his legs, and he has a positive Romberg sign. What might be the diagnosis and what are the next steps?
The male's presentation of progressive leg weakness, balance problems, and sensory loss, especially given the similar symptoms in his father, is suggestive of Friedreich's ataxia, an autosomal recessive genetic disorder that causes progressive damage to the nervous system. The next steps would include genetic testing to confirm the diagnosis by identifying repeats in the FXN gene. Management would involve a multidisciplinary team including physical and occupational therapy, and regular follow-up to manage progression and complications.