Case description

A 26-year-old woman presented with low back pain, perineal numbness, double incontinence and numbness involving her distal upper and lower limbs, with mild weakness of both legs. These symptoms followed a 3-week history of gastrointestinal illness. On neurological examination, there was weakness (Medical Research Council grade 4/5) of finger abduction and in proximal and distal leg muscles. Deep tendon reflexes were absent in both legs but normal in the arms. Pinprick sensation was diminished in the saddle area and the feet, with loss of vibration sense in the feet. MR scan of lumbar spine showed diffuse enhancement of all nerve roots in the cauda equina (figure 1). Cerebrospinal fluid (CSF) was acellular with elevated protein at 1.42 g/L (0.12–0.45). Nerve conduction studies, performed 4 weeks after symptoms onset, found prolonged …