Clinical Case of Atypical Botulism with Pseudointernuclear Ophthalmoplegia Syndrome
Botulism is a rare cause of bulbar and oculomotor syndromes. A late diagnosis and, therefore, late initiation of specific therapy may lead to multiple life-threatening complications. Epidemiological history and clinical findings are key to the correct diagnosis, but if these data are not available d...
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Research Center of Neurology
2024-10-01
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| Series: | Анналы клинической и экспериментальной неврологии |
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| Online Access: | https://annaly-nevrologii.com/journal/pathID/article/viewFile/998/pdf |
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| author | Alexander Yu. Kazantsev Irina V. Nikolaeva Irina F. Khafizova Bulat Sh. Fatkullin Julia M. Sozinova |
| author_facet | Alexander Yu. Kazantsev Irina V. Nikolaeva Irina F. Khafizova Bulat Sh. Fatkullin Julia M. Sozinova |
| author_sort | Alexander Yu. Kazantsev |
| collection | DOAJ |
| description | Botulism is a rare cause of bulbar and oculomotor syndromes. A late diagnosis and, therefore, late initiation of specific therapy may lead to multiple life-threatening complications. Epidemiological history and clinical findings are key to the correct diagnosis, but if these data are not available due to atypical clinical findings, botulism identification is challenging.
In our clinical case, a 31-year-old man was admitted to the hospital with double vision, impaired eye movements, and difficulty swallowing rapidly developing for 2 days. Ocular motility dysfunction included disturbed conjugate eye movements. In young patients, this is most often caused by demyelinating disease with medial (posterior) longitudinal fasciculus damage and symmetrical bilateral ptosis. The patient denied eating foods that could cause botulism and did not have any gastrointestinal symptoms. Differential diagnoses included demyelinating disease onset and Miller–Fisher syndrome. The next morning, completely identical clinical signs appeared in the patient’s mother who had eaten canned mushrooms, so botulism was suspected. Over the next few hours, despite the administration of anti-botulinum serum, acute respiratory failure developed, and the patient was placed on a ventilator for 28 days. The patient and his mother were discharged in a satisfactory condition, and their symptoms completely resolved within a few months. The diagnosis of botulism was confirmed by toxicological examination. |
| format | Article |
| id | doaj-art-98bd6dc18d0545faba5cd42b6aab3f3c |
| institution | OA Journals |
| issn | 2075-5473 2409-2533 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Research Center of Neurology |
| record_format | Article |
| series | Анналы клинической и экспериментальной неврологии |
| spelling | doaj-art-98bd6dc18d0545faba5cd42b6aab3f3c2025-08-20T02:12:42ZengResearch Center of NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-25332024-10-0118310310810.17816/ACEN.998699Clinical Case of Atypical Botulism with Pseudointernuclear Ophthalmoplegia SyndromeAlexander Yu. Kazantsev0https://orcid.org/0000-0001-9800-9940Irina V. Nikolaeva1https://orcid.org/0000-0003-0104-5895Irina F. Khafizova2https://orcid.org/0000-0003-2561-7456Bulat Sh. Fatkullin3https://orcid.org/0009-0004-3505-2166Julia M. Sozinova4https://orcid.org/0009-0000-0126-8808Kazan State Medical UniversityKazan State Medical UniversityClinical center “Neuroclinic of Professor Yakupov”Republican Clinical Infectious Hospital named by Professor A.F. AgafonovRepublican Clinical Infectious Hospital named by Professor A.F. AgafonovBotulism is a rare cause of bulbar and oculomotor syndromes. A late diagnosis and, therefore, late initiation of specific therapy may lead to multiple life-threatening complications. Epidemiological history and clinical findings are key to the correct diagnosis, but if these data are not available due to atypical clinical findings, botulism identification is challenging. In our clinical case, a 31-year-old man was admitted to the hospital with double vision, impaired eye movements, and difficulty swallowing rapidly developing for 2 days. Ocular motility dysfunction included disturbed conjugate eye movements. In young patients, this is most often caused by demyelinating disease with medial (posterior) longitudinal fasciculus damage and symmetrical bilateral ptosis. The patient denied eating foods that could cause botulism and did not have any gastrointestinal symptoms. Differential diagnoses included demyelinating disease onset and Miller–Fisher syndrome. The next morning, completely identical clinical signs appeared in the patient’s mother who had eaten canned mushrooms, so botulism was suspected. Over the next few hours, despite the administration of anti-botulinum serum, acute respiratory failure developed, and the patient was placed on a ventilator for 28 days. The patient and his mother were discharged in a satisfactory condition, and their symptoms completely resolved within a few months. The diagnosis of botulism was confirmed by toxicological examination.https://annaly-nevrologii.com/journal/pathID/article/viewFile/998/pdfbotulismmyasthenia gravisbulbar syndromeinternuclear ophthalmoplegiaptosismiller–fisher syndrome |
| spellingShingle | Alexander Yu. Kazantsev Irina V. Nikolaeva Irina F. Khafizova Bulat Sh. Fatkullin Julia M. Sozinova Clinical Case of Atypical Botulism with Pseudointernuclear Ophthalmoplegia Syndrome Анналы клинической и экспериментальной неврологии botulism myasthenia gravis bulbar syndrome internuclear ophthalmoplegia ptosis miller–fisher syndrome |
| title | Clinical Case of Atypical Botulism with Pseudointernuclear Ophthalmoplegia Syndrome |
| title_full | Clinical Case of Atypical Botulism with Pseudointernuclear Ophthalmoplegia Syndrome |
| title_fullStr | Clinical Case of Atypical Botulism with Pseudointernuclear Ophthalmoplegia Syndrome |
| title_full_unstemmed | Clinical Case of Atypical Botulism with Pseudointernuclear Ophthalmoplegia Syndrome |
| title_short | Clinical Case of Atypical Botulism with Pseudointernuclear Ophthalmoplegia Syndrome |
| title_sort | clinical case of atypical botulism with pseudointernuclear ophthalmoplegia syndrome |
| topic | botulism myasthenia gravis bulbar syndrome internuclear ophthalmoplegia ptosis miller–fisher syndrome |
| url | https://annaly-nevrologii.com/journal/pathID/article/viewFile/998/pdf |
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