Discussion
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 areflexia. Both the pupils are non-reactive. The most probable diagnosis is:
Answer: B
Correct answer: Botulism
The combination is characteristic: an acute descending paralysis beginning with the cranial nerves, blurred vision from failure of accommodation, and fixed non-reactive pupils from the block of parasympathetic cholinergic transmission. Poliomyelitis gives an asymmetrical flaccid paralysis with intact pupils and usually a febrile prodrome, and Guillain-Barré ascends rather than descends. Pupillary involvement in a descending paralysis points to botulism.
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