General physical examination was unremarkable. The possibilities of acute disseminated encephalomyelitis (ADEM), neuromyelitis optica spectrum disorder (NMOSD), multiple sclerosis (MS), myelin oligodendrocyte glycoprotein antibody disease, post-viral demyelination, post vaccinal demyelination, connective tissue disorders like systemic lupus erythematosus (SLE), vasculitis, and neuro-sarcoidosis were considered. Long segment of hyperintense signal C3-C6 is seen in the cervical cord on sagittal T2W images None of the lesions showed contrast enhancement. It showed hyperintensities in bilateral middle cerebellar peduncles and pons (Figure (Figure1, 1, ,2) 2) and hyperintense signals from C3 to C6 levels in the spine (Figure (Figure3). MRI of the brain and spine was performed.
All reflexes were brisk, and Babinski's reflex was extensor. In addition, the patient had urinary retention, for which catheterization was done. The power was grade 2/5 proximally and grade 3/5 distally in both upper and lower limbs), with diminished touch, pain, and vibration below C4 dermatome level.
On examination, the patient had complete paralysis of both upper and lower limbs. There was no history suggestive of connective tissue disorder, viral illness, trauma, or dog bite in the past. He had never had any similar episode in the past. The patient gave a history of his first dose of ChAdOx1 nCoV-19 coronavirus vaccination 20 days before all his symptoms started. No history of diplopia, decreased visual acuity, difficulty in swallowing, chewing, and breathing difficulty. He had a reduced sensation of pain and touch below the level of C4. On the third day of illness, the patient complained of urinary retention. A 26-year-old male presented to emergency with chief complaints of progressive bilateral upper and lower limb weakness for the past two days.
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