Case presentation:A 64-year-old man presented to our emergency department complaining of progressive ascending limb weakness and hand weakness for 6 weeks. 8 weeks before admission to hospital, he developed a severe headache with fever and chills that were treated symptomatically. 6 weeks before admission, he developed progressive right foot drop, followed a week later by left foot drop and difficulty walking. 4 weeks before admission, he noticed weakness in his right fourth and fifth digits, which soon involved all the fingers of his right hand. Within several days, he also noted weakness in his left hand. These symptoms prompted him to go to the emergency department. He denied concomitant fever, nausea, vomiting, diarrhoea, rash, shortness of breath, symmetric polyarthritis, or weight loss. He reported no sick contacts, recent travel, recent tick bites, or hiking through wooded areas. The patient had a history of well-controlled hypertension.^dDepartment of Neurosciences, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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