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.