Abstract

A 59-year-old cattle breeder hailing from rural north western India presented with insidious onset and gradually progressive hoarseness of voice and painless dysphagia for 5 months followed by ascending paraparesis and hearing loss for 2 months. He had significant loss of weight with anorexia of 5 months duration. Physical examination revealed pallor, bilateral 7th, 8th, 9th, 10th and left 12th cranial nerve palsies with sensorimotor deficits in radicular distribution (L3-S4) and neck stiffness. Hemogram showed elevated erythrocyte sedimentation rate of 42 mm in …

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