A 6-Year-Old Girl with Down Syndrome Is Brought to the Clinic

A 6-year-old girl with Down syndrome is brought to the clinic due to behavioral changes.  Over the past month, she has stopped running, tripped frequently while walking, and accidentally knocked toys over more often than normal.  The patient was toilet-trained at age 4, but recently she began having frequent urinary accidents while playing and has started wearing a diaper again.  Physical examination shows an ataxic gait.  Muscle tone is decreased throughout.  Bilateral ankle deep tendon reflexes are hyperreflexic.  When the soles of the feet are firmly stroked, the big toes move upward and the other toes fan out.  Urinalysis is normal.  Which of the following is the most likely cause of this patient's presentation?

A) Alzheimer disease
B) Atlantoaxial instability
C) Hypothyroidism
D) Spinal cord infarction
E) Tethered cord syndrome

Correct Answer:

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