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Acute Non-traumatic Weakness

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Acute Neuro Care

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Abstract

A 40-year-old male presented to the emergency with history of severe cramps, abdominal pain, diarrhoea and vomiting. He also complained of blurring of vision, dizziness, generalised weakness and mild difficulty in breathing. On verbalising he was finding it difficult to speak coherently. On examination his pulse rate was 90 beats per minute, BP was 160/90 mmHg and respiratory rate was 18. Neurological examination showed generalised weakness with slowing of reflexes. The attending physician ordered a CT scan, blood investigations and placed the patient under observation. Over 6 h the patient deteriorated further with complete flaccid paralysis and had to be intubated and mechanically ventilated to support respiration. With the preliminary blood investigations normal and the CT brain also showing no significant abnormalities the physician ordered for a toxicology screening. On interviewing the family, the patient was found to have consumed a portion of canned pickles the day before. Botulin toxins were detected in the blood and mouse bioassay also confirmed presence of toxins in the injected serum.

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Author information

Authors and Affiliations

  1. National Institute of Mental Health and Neurosciences, Bengaluru, India

    Venkataramaiah Sudhir & Kamath Sriganesh

Authors
  1. Venkataramaiah Sudhir
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  2. Kamath Sriganesh
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Editor information

Editors and Affiliations

  1. Division of Neuroanaesthesiology, Department of Anaesthesiology and critical care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

    Prasanna Udupi Bidkar

  2. Senior consultant and Head, Neuroanaesthesiology & Neurocritical care, MGM Healthcare Pvt Ltd, Chennai, Tamil Nadu, India

    Ponniah Vanamoorthy

Multiple Choice Question

Multiple Choice Question

  1. 1.

    All of these are a cause of periodic paralysis except,

    1. (a)

      Hyperkalemic periodic paralysis

    2. (b)

      Andersen–Tawil syndrome

    3. (c)

      Thyrotoxicosis

    4. (d)

      Botulism

  2. 2.

    Characteristics of infantile botulism include all except

    1. (a)

      Fever

    2. (b)

      Vomiting

    3. (c)

      Symmetrical weakness and profound hypotonia

    4. (d)

      Fixed dilated pupils

  3. 3.

    Proximal symmetric weakness of muscles with a heliotrope rash and swelled up hand, sensation being normal is seen in

    1. (a)

      Diabetic neuropathy

    2. (b)

      Radiculopathy

    3. (c)

      Dermatomyositis

    4. (d)

      Periodic Paralysis

  4. 4.

    Mees lines (horizontal hypopigmented lines across all nails) is a feature of

    1. (a)

      Arsenic poisoning

    2. (b)

      Lead toxicity

    3. (c)

      Dermatomyositis

    4. (d)

      Botulism

  5. 5.

    All of the following are appropriate in the management of weakness due to Anterior spinal artery syndrome except.

    1. (a)

      T2 weighted MRI to delineate the arterial territory.

    2. (b)

      Corticosteroids

    3. (c)

      Supportive therapy

    4. (d)

      Antiplatelet agents in patients with vascular disorders

  6. 6.

    The ideal antidote for organo-phosphorous compound is

    1. (a)

      Atropine

    2. (b)

      Pralidoxime

    3. (c)

      Flumazenil

    4. (d)

      Naloxone

  7. 7.

    Sudden onset hemiplegia with contralateral loss of pain and temperature sensations are a feature of,

    1. (a)

      Hemiplegic migraine

    2. (b)

      Brown-Sequard syndrome

    3. (c)

      Heavy metal poisoning

    4. (d)

      Acute porphyria

  8. 8.

    A 35-year-old female patient with a history of recent viral disease presented to the emergency with weakness and sensory disturbances below T2 level. Her weakness progressed slowly over days. She also complained of pain the back and bladder and bowel control were also lost. MRI revealed a segmental spinal lesion. The most probable diagnosis is?

    1. (a)

      Spinal Cord infarction

    2. (b)

      Transverse Myelitis

    3. (c)

      Guillain–Barre syndrome

    4. (d)

      Heavy metal toxicity.

  9. 9.

    Which of these naturally occurring toxins is responsible for muscular paralysis and even death in some cases after consumption of Puffer Fish?

    1. (a)

      Histamine

    2. (b)

      Ciguatoxin

    3. (c)

      Shellfish toxin

    4. (d)

      Tetrodotoxin

  10. 10.

    A 50-year-old gentleman who was a hypertensive on medication suddenly complained of severe chest pain both on the anterior and posterior aspect of the chest wall. By the time he reached the emergency he was profusely sweating and had developed monoplegia of the left hand. He described his pain as ‘searing’ chest pain. What could be the diagnosis?

    1. (a)

      Myocardial Infarction

    2. (b)

      Aortic dissection

    3. (c)

      Musculoskeletal pain

    4. (d)

      Severe pleuritis

Answers: 1. (d), 2. (a), 3. (c), 4. (b), 5. (b), 6. (b), 7. (b), 8. (b), 9. (d), 10. (b)

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Sudhir, V., Sriganesh, K. (2020). Acute Non-traumatic Weakness. In: Bidkar, P., Vanamoorthy, P. (eds) Acute Neuro Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-4071-4_14

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  • DOI: https://doi.org/10.1007/978-981-15-4071-4_14

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-4070-7

  • Online ISBN: 978-981-15-4071-4

  • eBook Packages: MedicineMedicine (R0)

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