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 are flexia. Both the pupils are non-reactive. The most probable diagnosis is :
Answer is B (Botulism) The clinical picture of the patient in question is consistent with a diagnosis of botulism. Symmetric descending paralysis is characteristic. Dizziness, Blurred vision and thy mouth are common. Ptosis is frequent. The papillary reflexes may be depressed and fixed or dilated pupils are noted in half of patients. - Regarding clinical manifestations of Botulism; Harrison 16th / 843 Characteristics of Botulism : CMDT 2006 / 1410; Harrison 16th / 843 History ofrecent ingestion of home canned or smoked food or injection of drug. Symmetric descending paralysis with prominent bulbar palsy 'D' of Bulbar palsy: `D'iplopia 'D 'ysahria `D'ysphonia `D'ysphogia Pupils are fixed and dilated in most cases - CMDT Ttosis, cranial nerve palsies with impairment of extraocular muscles and fixed dilated pupils are characteristic signs' - CMDT Normal sensory examination normal sensorium (not confused) Afebrile (Temperature remains normal)Q (Because Botulism is not an 'infection' but on 'intoxication' manifestation are due to the effect of toxin. Patient remains without fever until secondary infection is acquired). Diphteria Poliomyelitis, & Porphyria may all present with descending paralysis and bulbar palsy but fixed dilated pupils are characteristic of Botulism.
Poliornyelitis
Botulism
Diphtheria
Porphyria