A 53-year-old man developed a left-sided foot drop and a painful sensation on the ventral side of the foot and outer part of the lower leg. Two weeks later, the same symptoms also developed on the right side. In addition, he noticed progressive numbness of his lower legs. Three weeks later, he noticed weakness of his right hand, and was unable to spread his fingers. He had no other symptoms, and his medical history was not informative. He did not recall a tick bite or erythema migrans, or any pulmonary abnormality, and had not visited tropical countries. He does not sit with crossed legs.