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Noor1

Re: Re: What is your diagnosis?

errrrr...where in the history you mentioned she ate some old canned food you didnt provide a good H& P it can be anything .............phew!

[Edited by Noor1 on 15-07-2008 at 06:49 PM GMT]

[Edited by Noor1 on 15-07-2008 at 06:49 PM GMT]

nizam

Re: What is your diagnosis?

The final diagnosis was botulism.

nizam

What is your diagnosis?

A 55 year-old-woman with a known diagnosis of multiple sclerosis for the past 15 years presents with an acute onset of respiratory difficulties. Over the course of 3 days she goes in respiratory failure and is intubated for mechanical ventilation. During this period she also develops small bowel obstruction.

She is examined by her internist who reports the following examination. Patient is unreponsive to verbal and painful stimulation. Pupil are 7 mm dilated, fixed and unresponsive to light. Eyes are closed. There is no horizontal or vertical movements on dolls eye maneuver. There is no obvious cranial nerve asymmetry.

She has flaccid paralysis of all 4 extremities. Deep tendon reflexes are absent in all 4 limbs. Plantar reflexes are absent. On sternal rub she has minimal movement of toes on both feet. When you apply pressure on her finger nails she moves her toes bilaterally.

MRI of the brain shows demyelination plaques consistent with the previous diagnosis of MS but no lesion to account for the current symptoms. Spinal tap shows a normal cell count, protein and glucose. ECG is normal. WBC are normal and blood and urine cultures are negative. Chest x-ray is normal. EEG shows mild slowing in both hemispheres consistent with areas of demyelination otherwise it is normal.

Considering this history and examination, what is your differential diagnosis and how would you investigate?