Acute onset of blurred vision and absent pupillary response with rapidly progressive descending muscular weakness manifesting as quadriparesis in an afebrile 20 year old male with preserved sensorium is: (A) Porphyria, (B) Botulism, (C) Polio, (D) Diphtheria
Answer is B. Answer is B (Botulism): Sudden onset of blurred vision, absent pupillary reflexes (fixed /dilated pupil with lack of accomodation), symmetric descending paralysis progressing to qudriparesis and preserved sensorium suggest a diagnosis of Botulism. Cardinal Feature of Botulism Cranial Nerve Palsies with prominent bulbar palsy (4 'D's of Bulbar Palsy) (Diplopia, Dysahria, Dysphonia, Dysphagia, Ptosis, Loss of Accomodation, Fixed / Dilated pupils) Descending motor paralysis (Extent of paralysis from a few cranial nerves only to quadriperesis depends on dose of toxin) Symmetry of symptoms/signs A clear sensorium Absence of fever Lack of sensory findings