After computed tomography imaging, he was found to have spinal lipomatosis. syndrome, or paraplegia.3 The most common non-idiopathic causes of SEL are Z-WEHD-FMK chronic steroid use and morbid obesity.4 The most common symptom of SEL is bilateral lower extremity weakness.4,5 SEL is more prevalent in males with 75% of all SEL cases involving males. The median age for SEL is 43 years.4 Computed tomography and magnetic resonance imaging are used to make the diagnosis.6 Case Presentation A morbidly obese 43-year-old male was initially seen for bilateral hand and leg numbness and very mild weakness. At the time of examination, he only demonstrated mildly decreased sensation in his hands and feet, and subjective extremity weakness. He complained of not being able to walk but he had walked in unassisted during that first visit. He had no known medical problems except possible pre-diabetes, hypertension, and anxiety. He was not on any medications. He was a non-smoker and had never used any intravenous drugs. He had not had any instrumentation to his back, and he had not fallen or experienced any back trauma. A broad workup was done including general lab testing, all of which was normal. He was discharged home with specific instructions to follow-up with his primary care doctor to get a referral to neurology as his differential diagnosis included diabetic neuropathy or an underlying chronic neurologic condition such as multiple sclerosis. The Z-WEHD-FMK patient did see his internist but unfortunately was simply referred back to the emergency for neurology evaluation. On this second visit, he explained that he was progressively losing the ability to use his arms and legs and that he was unable to walk. He was unable to get himself to sit on the toilet, although he reported normal bowel and bladder function. He did have to come in via wheelchair. During this second visit, the further history of the present illness was obtained. A few weeks before the presentation the patient had visited the Dominican Republic where he caught a viral illness and developed multiple cold sores in his mouth. When he returned from this trip, Z-WEHD-FMK he experienced 1 week of diarrhea, which was then followed by weakness in his arms and legs. On review of systems, he denied fevers, chills, chest pain, shortness of breath, nausea, vomiting, diarrhea, abdominal pain, back pain, headache, bowel or bladder incontinence, or dysuria. His vital signs were temperature of 98F, pulse of 84 beats per minute, respiration rate of 16 breaths per minute, blood pressure 122/91 mmHg, 100% for his oxygen saturation on room air with a BMI of 46.3. On his physical exam, the patient had significant bilateral lower extremity weakness, which was new compared to the prior visit. It was slightly worse on the right than the left. He was completely unable to lift the leg on the right and even when it was lifted up for him, it dropped to the bed. On the left, he could not sustain lifting his leg but he was able to have it gently come down to the bed. His National Institutes of Health Stroke Scale (NIHSS) was 5 due to these motor deficits. He had a weak handgrip with a score of 3/5 in Pcdha10 both hands. He had a normal finger-to-nose bilaterally. He had questionably diminished reflexes in the lower extremities, and intact reflexes in the upper extremities. His sensation was intact in both his lower extremities. He had fine motor movement difficulty in both his hands. Cranial nerve Z-WEHD-FMK examination was normal. There was no dystonia, no fasciculations, no myoclonus or tremor as well as.