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A 64-year-old dance teacher with a history of type 2 diabetes and hypertension presented with interscapular pain and sudden onset of weakness in all limbs, affecting the legs more than the arms. During the 2 weeks between presentation to a rural doctor and admission to the hospital, the weakness was static, but the patient developed urinary incontinence that required bladder catheterization. He had been taking simvastatin, enalopril, gliclazide, and metformin. One year ago, he had had a toe-ectomy for an ischemic diabetic toe.
On examination, he was apyrexial. Atrial fibrillation was present. The rest of the system examination was normal. There was local spinal tenderness over the dorsal spine. The patient had no meningism, but on flexion of…