Table 1

- Patient timeline of disease evolution.

Ages	Symptoms	Treatment and response
44 years old	Inflexibility and weakness of his left leg when he stepped on a bus.	No treatment
46 years old	Two episodes of exacerbation of left leg weakness and he had difficulty in climbing upstairs and riding a bicycle.	He was treated as ischemic stroke but with no effect.
47 to 48 years old	He had three episodes of numbness and weakness of the left limbs. From this time, he developed urinary incontinence.	He was treated as multiple sclerosis using methylprednisolone 500 mg qd × 5 days, with limited alleviation.
50 years old	Stiffness on the buttock and legs and difficult in walking.	Intramuscular injection of cobalamin 500 µg/day and oral folate 5 mg/day for one month, oral aspirin 100 mg/day, rosuvastatin 10 mg/day, but showed no improvement.
52 years old	Telephone follow up	Symptoms worsen gradually and he has to stay in wheelchair.