Acute paraplegia is an emergency requiring immediate assessment by the acute medical team because of the need to rule out compressive lesions of the cord. Early intervention may preserve neurological spinal function and limit persistent disability. In addition, acute paraplegia may be complicated by life-threatening problems. These require prompt recognition and treatment. The following clinical scenario, based on a real case of acute paraplegia managed by the authors is aimed at providing a problem-based approach to the management of patients presenting with acute paraplegic weakness.