A 6-year-old Red and White Holstein cow presented to Cornell’s Farm Animal Hospital on June 3, 2012 with a one-day history of persistent recumbency following a dystocia. The patient went down immediately after calving and was treated on the farm with calcium. The patient was bright and had a normal appetite at home; however, she remained recumbent and was sent to Cornell. On presentation, the patient was quiet, alert, and responsive, but unable to rise from sternal recumbency in the livestock trailer. Upon further examination, a bilateral peripheral neuropathy involving the sciatic nerves was detected. Supportive care, including the use of a floatation tank, was initiated. This paper will provide a review of the case with a focus on the diagnosis, pathogenesis, and treatment of a downer cow.