Case 1

A 24-year-old man presents to the ED with weakness and shortness of breath.

He says that over the last week he has become so weak that he is unable to lift his arms above his head. He has now noticed his legs are becoming weak and that he cannot walk unaided.

He is normally fit and well, but did have a stomach upset three weeks previously.

His observations are as follows:
Temp: 36.5
P: 70
RR: 24
BP: 130/74
Sats: 94 on air

He has grade 3/5 power in his arms bilaterally, and 4/5 power in his legs bilaterally.

Tendon reflexes are globally reduced. Sensory examination is normal in his legs, with mild patchy changes in the arms.

Amongst other investigations, a lumbar puncture is performed which shows an absence of red and white cells, and a protein level of 0.8g/L.