An Asymmetric Onset of Neurological Signs Does Not Rule Out the Botulism

Marina Trivisano, Giuseppe d&r

Abstract

Foodborne Botulism is clinically characterized by a symmetric flaccid paralysis of the cranial nerves with a descending involvement of voluntary and breathing muscles leading to respiratory arrest. Asymmetric neurological signs are unusual and in these cases diagnosis could be delayed or frequently missed. We described a 63-year-old man with a clinical picture related to type A botulism characterized by an asymmetric and left lateralized onset of neurological signs associated with a monolateral parotitis. Physicians must be aware that lateralized onset of neurological signs does not rule out the botulism, and it should be considered even in cases of atypical clinical picture.

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