A 20 years old female came to ED with c/o giddiness since 4 days, headache since 3 days with diplopia with slurring of speech, lower limb weakness, difficulty in swallowing, and dropping of left eyelid since 1 day. Patient had no any pre-existing comorbidity and not on any regular medication. Last menstrual period was on 5 days back. On examination Patient was vitally and haemodynamically stable. Diplopia on right sided distant vision present. Venous blood gas samples showed Hyponatremia. On CNS examination the Glasgow coma scale was 15/15 with power in upper and lower limb 5/5 bilaterally. There was no neck stiffness. Gag reflex present.

Patient was taken immediately on symptomatic supportive treatment and admitted in Intensive care unit. Patient was planned for contrast enhanced MRI brain, lumbar puncture for CSF study, chest x-ray, ultrasound whole abdomen. Blood samples for complete haemogram and other relevant blood investigations with serum electrolytes sent for further study.