Teaching NeuroImages: Hopkins syndrome

An 11-year-old Brazilian boy presented with worsening left thigh weakness. At age 2 years, he presented with left lower limb weakness after 4 days of a severe asthma episode. Examination showed amyotrophy, weakness, and areflexia of the left lower limb (figure). Spine MRI and CSF analysis (including serology and PCR for herpesvirus, enterovirus, and arbovirus) were unremarkable. Neurophysiologic studies exhibited ongoing denervation and chronic...