Case Presentation: This is the case of a 44-year-old Hispanic male with a history of polysubstance use (alcohol, marijuana and cocaine) and vitamin B12 deficiency presented to the emergency department with lower limb weakness, fasciculations, spasms, paresthesia, ataxia, left-sided blurry vision, emesis and intractable hiccups for several days. He initially symptoms started in September 2018 [...]