 On examination, blood pressure 138/82, pulse 90, respiratory rate 14, and weight 176.5 pounds.  Pain scale is 0.  A full general and neurological examination was personally performed and is documented on the chart.  Of note, she has a normal general examination.  Neurological examination reveals normal cognition and cranial nerve examination including normal jaw jerk.  She has mild postural tremor in both arms.  She has mild decreased sensation in the right palm and mild decreased light touch in the right palm and decreased vibration sense in both distal lower extremities.  Motor examination reveals no weakness to individual muscle testing, but on gait she does have a very subtle left hemiparesis.  She has hyperreflexia in her lower extremities, worse on the left.  Babinski's are downgoing.