What would you do if you woke up one morning and found that you could not stand, your legs simply won’t move.

This was exactly what the patient in this, our 10 000th case at BMJ Case Reports, discovered.

He presented to the Accident and Emergency Department with sudden bilateral lower limb paralysis and urinary retention. How would you manage his care? What would you do? He needs urgent attention. Is this trauma? Is there cord compression? Could this be Guillain – Barre? Could the paralysis become generalized? Will he stop breathing?

Put yourself in this patient’s position. How would you feel? Put yourself in the admitting doctor’s position. There is a need to act fast. Multiple disciplines will need to consult. The patient may need intensive care.

What is your working diagnosis? What do you need to exclude? How will you investigate?

Read on and tell us what you would do. How would discover what is wrong? How would you discuss this with the patient? What about his family?

Read on and find out whether the symptoms improve…. Sudden flaccid paralysis