Advertisement

Acute Non-traumatic Weakness

  • Venkataramaiah Sudhir
  • Kamath Sriganesh
Chapter
  • 92 Downloads

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.

References

  1. 1.
    Yeager S, Miller C. Acute nontraumatic weakness: overview of central nervous system differential diagnosis. AACN Adv Crit Care. 2014;25(3):251–65.CrossRefGoogle Scholar
  2. 2.
    Caulfield AF, Flower O, Pineda JA, Uddin S. Emergency neurological life support: acute non-traumatic weakness. Neurocrit Care. 2017;27(Suppl 1):29–50.  https://doi.org/10.1007/s12028-017-0450-3.CrossRefPubMedGoogle Scholar
  3. 3.
    Ganti L, Rastogi V. Acute generalized weakness. Emerg Med Clin North Am. 2016;34(4):795–809.CrossRefGoogle Scholar
  4. 4.
    Nayak R. Practical approach to the patient with acute neuromuscular weakness. World J Clin Cases. 2017;5(7):270–9.  https://doi.org/10.12998/wjcc.v5.i7.270.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Rabinstein AA. Noninvasive ventilation for neuromuscular respiratory failure: when to use and when to avoid. Curr Opin Crit Care. 2016;22(2):94–9.PubMedGoogle Scholar
  6. 6.
    Kumar S, Kaul S. Approach to a patient with hemiplegia and monoplegia. Available at http://www.apiindia.org/pdf/progress_in_medicine_2017/mu_27.pdf.
  7. 7.
    Jacob John T, Vashishtha VM. Eradicating poliomyelitis: India’s journey from hyperendemic to polio-free status. Indian J Med Res. 2013;137(5):881–94.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Suresh E, Wimalaratna S. Proximal myopathy: diagnostic approach and initial management. Postgrad Med J. 2013;89(1054):470–7.CrossRefGoogle Scholar
  9. 9.
    Dimachkie MM, Barohn RJ. Distal myopathies. Neurol Clin. 2014;32(3):817–42.  https://doi.org/10.1016/j.ncl.2014.04.004.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Neal S, Fields KB. Peripheral nerve entrapment and injury in the upper extremity. Am Fam Physician. 2010;81:147–55.PubMedGoogle Scholar
  11. 11.
    Mathew L, Talbot K, Love S, Puvanarajah S, Donaghy M. Treatment of vasculitic peripheral neuropathy: a retrospective analysis of outcome. QJM. 2007;100:41–51.CrossRefGoogle Scholar
  12. 12.
    London Z, Albers JW. Toxic neuropathies associated with pharmaceutic and industrial agents. Neurol Clin. 2007;25:257–76.CrossRefGoogle Scholar
  13. 13.
    Meena AK, Khadilkar SV, Murthy JM. Treatment guidelines for Guillain–Barre syndrome. Ann Indian Acad Neurol. 2011;14:S73–81.CrossRefGoogle Scholar
  14. 14.
    Alter M. The epidemiology of Guillain-Barré syndrome. Ann Neurol. 1990;27(Suppl):S7–S12.CrossRefGoogle Scholar
  15. 15.
    Juel VC. Myasthenia gravis: management of myasthenic crisis and perioperative care. Semin Neurol. 2004;24:75–81.CrossRefGoogle Scholar
  16. 16.
    Varma JK, Katsitadze G, Moiscrafishvili M, et al. Signs and symptoms predictive of death in patients with foodborne botulism—Republic of Georgia, 1980–2002. Clin Infect Dis. 2004;39:357–62.CrossRefGoogle Scholar
  17. 17.
    Chalk C, Benstead TJ, Keezer M. Medical treatment for botulism. Cochrane Database Syst Rev. 2011;16(3):CD008123.Google Scholar
  18. 18.
    Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283:897–903.CrossRefGoogle Scholar
  19. 19.
    Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ. Neurological symptoms in type A aortic dissections. Stroke. 2007;38:292–7.CrossRefGoogle Scholar
  20. 20.
    Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation. 2005;112:3802–13.CrossRefGoogle Scholar
  21. 21.
    Colak N, Nazli Y, Alpay MF, Akkaya IO, Cakir O. Painless aortic dissection presenting as paraplegia. Tex Heart Inst J. 2012;39(2):273–6. PMID: 22740752.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Park C-B, Jo D-J, Kim M-K, Kim S-H. Paraplegia due to acute aortic coarctation and occlusion. J Korean Neurosurg Soc. 2014;55(3):156–9.CrossRefGoogle Scholar
  23. 23.
    Venance SL, Cannon SC, Fialho D, et al. The primary periodic paralyses: diagnosis, pathogenesis and treatment. Brain. 2006;129:8–17.CrossRefGoogle Scholar
  24. 24.
    Lorizzo LJ 3rd, Jorizzo JL. The treatment and prognosis of dermatomyositis: an updated review. J Am Acad Dermatol. 2008;59:99–112.CrossRefGoogle Scholar
  25. 25.
    Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet. 2008;371:597–607.CrossRefGoogle Scholar
  26. 26.
    Garg RK, Malhotra HS, Verma R, Sharma P, Singh MK. Etiological spectrum of hypokalemic paralysis: A retrospective analysis of 29 patients. Ann Indian Acad Neurol. 2013;16(3):365–70.CrossRefGoogle Scholar
  27. 27.
    Kumar Singh A, Kumar Maurya P, Kulshreshtha D, Deepak Thakkar M, Kumar TA. Analysis of clinical and metabolic profile of acute neuromuscular weakness related to Hypokalemia. Acta Neurol Taiwanica. 2017;26(3):97–105.Google Scholar
  28. 28.
    Statland JM, Fontaine B, Hanna MG, Johnson NE, Kissel JT, Sansone VA, Shieh PB, Tawil RN, Trivedi J, Cannon SC, Griggs RC. Review of the diagnosis and treatment of periodic paralysis. Muscle Nerve. 2018;57(4):522–30.  https://doi.org/10.1002/mus.26009. Published online 2017 Nov 29.CrossRefPubMedGoogle Scholar
  29. 29.
    Ohshita T, Imamura E, Nomura E, Wakabayashi S, Kajikawa H, Matsumoto M. Hypoglycemia with focal neurological signs as stroke mimic: clinical and neuroradiological characteristics. J Neurol Sci. 2015;353(1–2):98–101.CrossRefGoogle Scholar
  30. 30.
    Wallis WE, Donaldson I, Scott RS, Wilson J. Hypoglycemia masquerading as cerebrovascular disease (hypoglycemic hemiplegia). Ann Neurol. 1985;18(4):510–2.CrossRefGoogle Scholar
  31. 31.
    Riggs JE. Neurologic manifestations of electrolyte disturbances. Neurol Clin. 2002;20:227–39.CrossRefGoogle Scholar
  32. 32.
    Sebastian S, Clarence D, Newson C. Severe hypophosphataemia mimicking Guillain–Barre syndrome. Anaesthesia. 2008;63:873–5.CrossRefGoogle Scholar

Copyright information

© The Editor(s) (if applicable) and The Author(s)  2020

Authors and Affiliations

  • Venkataramaiah Sudhir
    • 1
  • Kamath Sriganesh
    • 1
  1. 1.National Institute of Mental Health and NeurosciencesBengaluruIndia

Personalised recommendations