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Một bồi bàn 45 tuổi của Trung Quốc thức dậy với tầm nhìn bị mờ và ptosis song phương. Ông cảm thấy buồn nôn và nôn mửa nhiều lần. Ngày hôm sau, ông đã hoàn thành ophthalmoplegia, dysarthria, khó nuốt, và khó thở. | 42 6. Peripheral Nervous System Disorders Treatment The treatment is similar to that for typical GBS with IVIG or PE. Disorders of the Neuromuscular Junction Botulism Vignette A 45-year-old Chinese waiter woke up with blurry vision and bilateral ptosis. He felt nauseated and vomited several times. The next day he had complete ophthalmoplegia dysarthria difficulty swallowing and shortness of breath. Neurological examination showed marked limitation of horizontal gaze and upgaze ptosis facial diplegia and a weak tongue with no fasciculations. Pupils were dilated and not reactive. Neck flexors and extensor and proximal limb muscles were weak. Deep tendon reflexes were diminished and sensation was normal. Summary A 45-year-old man presenting with the acute onset of rapidly progressive bulbofacial extraocular respiratory and neck muscle weakness accompanied by poor pupillary responses and hyporeflexia. Localization It is important to determine which component of the motor unit is involved anterior horn cell peripheral nerve neuromuscular junction or muscle. Among the disorders of the peripheral nerve causing acute weakness the entities to consider are Guillain-Barre syndrome diphtheric polyneuropathy and porphyric polyneuropathy. Guillain-Barre syndrome is characterized by rapidly progressive relatively symmetrical weakness involving the proximal and distal muscles usually with an ascending pattern that tends to involve the lower extremities first and is associated with hyporeflexia or areflexia. Sensory symptoms such as numbness paresthesias and even moderate or severe pain involving the limbs and lower back can also occur. A rare descending presentation that can simulate botulism or diphtheria is the pharyngeal-cervical-brachial variant described by Ropper with involvement of the facial oropharyngeal neck and upper extremity muscles which can create some diagnostic difficulties. Diphtheria which also enters the differential diagnosis of the case presented in the .
