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MRI of the lumbar spine at L3 level (left); enhancement of the cauda equina roots after gadolinium (right). The roots remain discrete.clotting function which was corrected with fresh frozen plasma. The CSF was turbid with 6000 white cells per mm3, 90% of which were polymorphonuclear cells, and a protein concentration of 0-6 g/l. Antibiotic treatment with cefotaxime and benzylpenicillin was instituted with the benzylpenicillin alone being continued when both blood and CSF cultures showed Neisseria meningitidis.By the fifth day he had persistent headache but was oriented. He complained of lumbar backache and leg pain with unsteadiness, and failed a trial without a urinary catheter because of urinary retention. He was unable to stand for more than a few seconds and could not walk at all; he was also faecally incontinent. Examination on the 12th day of his illness showed him to be confined to bed, afebrile, alert, and fully oriented without signs of meningism. He had no papilloedema and no cranial nerve signs. Apart from a depressed left triceps reflex he had no signs in the arms. There was a severe flaccid asymmetric leg weakness, worse on the left, with all tendon reflexes, except for that at the right knee, being absent even with reinforcement.Both plantar responses were flexor. There was impaired pinprick sensation from L4 to S5 bilaterally. Proprioception was impaired in the right toes and in the right ankle.

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