An 18-year-old male presented with acute onset a history of blurring of vision for the same duration on examination, the patient has quadriparesis with areflexia. Both the pupils are non-reactive. The most probable diagnosis is –
Correct Answer: Botulism
Description: Ans. is 'b' i.e., Botulism o The clinical picture of the patient in question is consistent with a diagnosis of botulism.o Symmetric descending paralysis is characteristic. Dizziness, Blurred vision and dty mouth are common. Ptosis is frequent. The pupillary reflexes may be depressed and fixed or dilated pupils are noted in half ofpatients.BotulismBotulism is caused by botulism toxin, which is the most toxic substance known,|||Food Borne BotulismWound BotulismIatrogenic BotulismCaused by ingestion of food contaminated by preformed botulinum toxin.Caused by wounds contaminated with Clostridium botulism sporesResults from injection of toxinThe diagnosis of botulism is usually made clinicallyo The clinical syndrome of botulism is dominated by neurological signs and symptoms resulting from blockade of neurotransmission at voluntary motor and cholinergic junctions.o Patients with botulism usually present with acute onset of weakness in muscles innervated by the cranial nerves. Onset of symptomatic illness include Blurred vision secondary-> to fixed pupillaty dilation and palsy of cranial nerve HI, IV and VI.# Diplopia# Dysphagia# Dysarthria# Ptosis# Facial weakness# Depressed pupillary reflexes (pupil fixed and dilated).o In severe cases descending symmetric weakness occurs often leading to paralysis.o Deep tendon reflexes are progressively lost.o May presents with evidence of autonomic dysfunction.# Dry mouth# Blurred vision# Orthostatic hypotension# Urinary retention# Constipationo Sensory abnormalities are ah sen t, because only motor and autonomic nerves affected.o Mental function usually not affected.o Patients are usually afebrile.o The united states centre for disease controi and prevention has suggested that following should be considered kev. feature of Botulism.# Absence of fever# Symmetic neurologic deficit# No sensory deficit# Patient remains responsive# Normal or slow heart rate
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