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A 24-year-old man was transferred to the accident and emergency department with generalised seizures. He complained of headache, blurred vision and low backache after recreational cocaine use over the preceding few days. His condition deteriorated rapidly. He developed bilateral leg weakness, and his urine output had tailed-off. His blood pressure was 240/130 mm Hg. Clinical examination revealed global lower limb weakness (4 out of 5), with spastic tone bilaterally. His knee and ankle joint reflexes were …
Competing interests: None declared.
Patient consent: Obtained.
Acknowledgement: Professor Peter Mathieson.
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