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Old 04-17-2011
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Question Facial weakness after meal

A 60-year-old woman presents to the emergency department with nausea, vomiting, abdominal pain, and diarrhea for the last 24 hours. She also has had double vision, difficulty speaking, and facial weakness for the last 6 hours. Her husband who shared the meal experienced similar symptoms. Physical examination shows nystagmus, dysphagia, dysarthria, and bilateral facial weakness. There is no skin rash. What is the most likely cause?

A. Bacillus anthracis
B.
Borrelia burgdorferi
C.
Clostridium botulinum
D.
Staphylococcus aureus
E.
Trichinella spiralis
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Old 04-17-2011
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The answer would be C. Clostridium botulinum
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C. Clostridium botulinum
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Spot on! Yes. Botulism!

Transmitted through ingestion of contaminated canned food. GI symptoms and sudden cranial nerve deficits.

Why not the others? They also can present with neurology, can't they? Any one - help!
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Quote:
Originally Posted by noothan View Post
C. Clostridium botulinum
can u explain it?
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i'll go with c
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Quote:
Originally Posted by 1TA2B View Post
Spot on! Yes. Botulism!

Transmitted through ingestion of contaminated canned food. GI symptoms and sudden cranial nerve deficits.

Why not the others? They also can present with neurology, can't they? Any one - help!
Well, here is my 2 cents :
- First off look at the onset , short onset is usually food poisoning. However there is Butulism is usually associated with canned food. There is no mention of that in the question.
- Anthrax usually causes lung issues and is most effective when inhaled.
- Borrelia burgdorferi is better known for Lyme disease.
- S. aureus : can anyone comment on why not this?
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Smile my single penny, here it comes..:)

Trichinella Spiralis, a nematod, usually takes more than 2 days to cause symptoms which are nausea, vomiting, diarrhea and facial edema.
May take 12 hours if there is heavy infestation, most importantly, does not have any predilection for nerves.

PS: it is highly unlikely that 2 persons get the same infestation and exhibit same symptoms simultaneoulsy with trichinosis

Staph Aureus
It's toxin can produce food poisoning in 6 hours but most dominant element would be vomiting not diarrhea. Can cause range of skin lesions varying from impetigo, cellulitis to toxic shock syndrome to SSSS. No known predilection for nerves too as mentioned in case history
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Thanks DrKEMC and Armin

Helpful!
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Well the explaination are damn good !!

I went for Botulism coz of the nerve involvement .
classical signs like double vision

For the rest of the explaination....thanks doctorkem and Armin
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Quote:
Originally Posted by doctorKEMC View Post
Trichinella Spiralis, a nematod, usually takes more than 2 days to cause symptoms which are nausea, vomiting, diarrhea and facial edema.
May take 12 hours if there is heavy infestation, most importantly, does not have any predilection for nerves.

PS: it is highly unlikely that 2 persons get the same infestation and exhibit same symptoms simultaneoulsy with trichinosis

Staph Aureus
It's toxin can produce food poisoning in 6 hours but most dominant element would be vomiting not diarrhea. Can cause range of skin lesions varying from impetigo, cellulitis to toxic shock syndrome to SSSS. No known predilection for nerves too as mentioned in case history
Oh yeah, the projectile vomit ..
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