Amyotrophic Lateral Sclerosis (ALS): This is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord, leading to loss of muscle control. ALS often presents with a combination of upper and lower motor neuron signs, including hyperreflexia, which matches the symptoms described.

Multiple Sclerosis (MS): An autoimmune disease that affects the brain and spinal cord, leading to a wide range of neurological symptoms, including hyperreflexia and coordination issues that could result in abnormal heel-to-shin and finger-to-nose tests.
Spinal Cord Injury or Compression: Conditions such as herniated disks, spinal stenosis, or traumatic injuries can compress the spinal cord, leading to hyperreflexia and coordination problems in the lower extremities.
Stroke or Cerebral Vasculitis: Certain types of stroke or cerebral vasculitis can affect motor control areas of the brain, leading to hyperreflexia and coordination issues.

Subacute Combined Degeneration (Vitamin B12 Deficiency): A condition caused by vitamin B12 deficiency, leading to demyelination of the spinal cord, which can present with hyperreflexia, gait disturbances, and other neurological symptoms. Early diagnosis is crucial for treatment and prevention of irreversible damage.
Spinal Cord Tumors: Both benign and malignant tumors can compress the spinal cord, leading to a range of neurological symptoms, including hyperreflexia and coordination problems.

Adrenoleukodystrophy: A rare genetic disorder that affects the brain and spinal cord, leading to demyelination and a range of neurological symptoms, including hyperreflexia.
Tropical Spastic Paraparesis (HTLV-1 Associated Myelopathy): A rare condition caused by the HTLV-1 virus, leading to progressive spastic paraparesis, which includes hyperreflexia and gait disturbances.
Hereditary Spastic Paraplegia: A group of rare genetic disorders characterized by progressive spasticity and weakness of the lower limbs, which can include hyperreflexia and coordination issues.