Abstract
A previously healthy 12-year-old boy was admitted with a subacute right facial droop, deteriorating handwriting, and frequent falls. Examination revealed mild hemiparesis, lower motor neuron facial palsy, and a positive Babinski reflex on the right side. He also exhibited ataxia and bilateral dysmetria. During the next few months, he progressively developed quadriparesis, bilateral internuclear ophthalmoplegia, multiple cranial nerve palsies, a pseudobulbar affect, and a hyperreflexic neurogenic bladder.
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