Case history:
A 73-year-old gentleman, active smoker, with medical history of
hypertension and well-controlled rheumatoid arthritis, presented to the
emergency department with 3-4 days’ complaints of progressive bilateral
lower limb weakness which prevented him from carrying out his activities
of daily living. He previously had an excellent functional status and
denied any history of recent trauma, fever, upper respiratory or
gastrointestinal tract illness. There was no weight loss, night sweats
or change in bowel habits. He had received the second dose of COVID-19
vaccine (Pfizer) 20 days prior to his presentation.
On physical examination, the patient was vitally stable, afebrile and on
room air with no signs of distress. Neurological examination showed
intact sensation in both upper and lower limbs. Motor strength according
to Medical Research Council grade was 5/5 in upper limbs and 3/5 in both
lower limbs, proximally and distally. The patient was not able to walk
or maintain sitting posture on his own. His reflexes were absent in the
ankles, reduced in the knees bilaterally (1/4) and normal in the upper
limbs. There was no nystagmus or dysdiadochokinesia. Examination of the
cranial nerves and other systems was normal.