Investigations:
Complete blood count showed mild leukocytosis of 11.9 x 103/uL (reference range 4-10 x 103/uL) with neutrophilic predominance, and normal hemoglobin and platelet count. His renal, hepatic and coagulation profile were normal. C-reactive protein was elevated at 54 mg/dl (reference range 0 - 5 mg/dl). COVID-19 PCR from a nasopharyngeal swab was negative. Computed tomography (CT) and magnetic resonance imaging of the brain were negative for any acute insult in the cerebellum and brainstem. A lumbar puncture was performed, and cerebrospinal fluid analysis showed normal glucose in addition to normal white and red blood cell counts. Additionally, CSF analysis showed elevated protein at 0.8 gm/L (reference range 0.15 - 0.45 gm/L) and elevated albumin at 421 mg/L (reference range 0 - 350 mg/L). Gram stain and culture of the fluid were negative. Oligoclonal band from the CSF was negative as well. Computed tomography (CT) and MRI of the brain were negative for any acute insult in the cerebellum and brainstem. MRI of the spine showed bilateral nerve root enhancement in the lumbar region and the upper part of the cauda equina (Figure 1). Nerve conduction study (NCS and electromyogram (EMG) showed bilateral absent H reflexes in the gastrocnemius muscles consistent with early polyneuroradiculopathy.