Sudden loss of sensation
A 33 year old female teacher presented to hospital with a 10 day history of reduced sensation in both legs. She reported tingling in the left lower leg progressing overnight to involve both legs reaching mid-thigh level. Over the following 24 hours, the sensory loss had ascended to the level of the umbilicus and she was unable to feel her underwear. Her symptoms progressed throughout the next seven days until the reduced sensation extended to just beneath her breasts. She denied any visual disturbance, limb stiffness or weakness, or urinary or faecal incontinence. She developed a shuffling gait because of reduced sensation in her feet.
On examination, she had no meningeal signs such as neck stiffness or photophobia, and examination of her cranial nerves, motor system, and coordination were normal. She had brisk lower limb reflexes and down going plantars. Sensation to soft touch and pinprick was reduced bilaterally below