Case History/examination
A 59-year-old Caucasian man with a history of hypertension, polycythemia, central retinal artery occlusion, and optic neuritis presented with worsening painless right visual impairment and bilateral lower extremity (LE) weakness. His visual loss, which began a year ago, persisted despite a 5-day course of IV Solu-Medrol and 6 months of oral steroids. Additionally, he reported progressive weakness in both legs over 3 months, requiring increasing mobility aids, and new-onset urinary and fecal incontinence. On examination, his visual acuity was limited to ”counting fingers” bilaterally, with proximal LE strength at 2/5 and distal LE strength at 3/5, alongside hyperreflexia.