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A 29-year-old previously healthy man presented with a diarrhoeal illness, headache and malaise while in South Africa where he had been living for 6 months. Two weeks later, he developed diplopia and incoordination.
Neurological examination revealed a left internuclear ophthalmoplegia (INO) and limb ataxia. The rest of his cranial nerve examination was normal as was tone, power, reflexes and sensation in his limbs. His general systemic examination was unremarkable; in particular, there were no skin lesions. …
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.