In this case, there is enhancement of the anterior nerve roots of the cauda equina. This can be seen in Guillain-Barré syndrome. However, with the T2 hyperintensity of the anterior horn cell and accompanying enhancement, this diagnosis does not fit.

Instead, think of polio virus infection and enterovirus 71 infection, the latter of which was confirmed on PCR. In 2017, there was an outbreak of enterovirus D68 infection. This predominantly affected the upper limbs with associated brainstem signal abnormality.