An 18-year-old male presented with acute onset descending paralysis of 3 days duration. There is also a history of blurring of vision for the same duration. On examination, the patient has quadriparesis with areflexia. Both the pupils are non-reactive. What is the MOST probable diagnosis in this patient?
Correct Answer: Botulism
Description: The presence of acute onset of descending paralysis together with diplopia and non reactive pupils suggests a diagnosis of Botulism. Botulism is caused by the botulinum toxin produced by Clostridium botulinum. This toxin cause inhibition of acetylcholine release at the neuromuscular junction through an enzymatic mechanism. Patients presents with symmetric cranial nerve palsies followed by symmetric descending flaccid paralysis that may progress to respiratory arrest and death. Cranial nerve involvement produces diplopia, dysphonia, dysphagia and dysahria. It is followed by flaccid, descending, symmetric paralysis of the voluntary muscles. Pharyngeal collapse secondary to cranial nerve involvement can compromise the airway. Extraocular muscle paralysis manifests as blurred vision or diplopia and an inability to accommodate near vision. patients can have ptosis, facial paralysis, depressed pupillary reflexes with fixed, dilated pupils. Ref: Harrison's Principles of Internal Medicine, 18e chapter 141, By Jeremy Sobel; Susan Maslanka.
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