Problem: A 20-year-old college student was playing pool late one night. Three weeks previously, he had a viral illness, but his symptoms had resolved. Suddenly, in the pool hall, he developed headache, nausea, confusion, and complained of weakness of both legs. He also could not hold his urine and had urinary incontinence. His roommate carried him to the infirmary for evaluation.
On examination the patient was lethargic, with some slurring of his speech. His vitals were stable and he was afebrile. General examination was normal. Neurological examination was significant for weakness in his lower extremities, but he was able to stand. Gait was significantly unsteady and he required assistance with walking. His reflexes were diffusely increased with bilateral up going toes. His sensory examination revealed a subjective sensory level at the level of his naval. The patient was admitted for evaluation and management.