In this enlightening discussion, Andrew Sanchez, a hospitalist-educator, presents a perplexing case of bilateral leg weakness while Aaron Berkowitz, a neurologist, guides the analysis through differential diagnoses. Sarah K Blaine, an aspiring neurologist, joins the conversation, exploring the nuances of spinal versus peripheral causes and the significance of symptoms like weight loss and atrophy. The group delves into diagnostic strategies, discussing the implications of lab results and imaging in pursuit of clarity amidst uncertainty.