Toxin inhibits (pre-synaptic) ach release at NMJ--> flaccid paralysis
Risk Factors
Dirty wounds
Bioterrorism
Acquired via food (improperly canned)
Injection of contaminated black tar heroin (skin popping)
Overdose/misplaced injection of cosmetic botox
Symptoms
Dysphonia
Double vision
Blurred vision
Acute onset→ 8-36h
Affects cranial nerves first and then typically descends
Symptoms are usually symmetric
Dysphagia, difficulty swallowing secretions
SOB/difficulty breathing
Abdominal cramps, constipation, urinary retention
Degree of symptoms varies with quantity of exposure to toxin
Physical Exam Findings
Afebrile
Ptosis
Abnormal voice
Normal mental status
Weakness/paralysis starts w/CNs→ spreads symmetrically to limbs
Impaired extra-occular movements
Sometimes dilated pupils
Muscle fatigability, which can be demonstrated by having patient look upwards x 10 sec (brings out ptosis); repeated muscle testing of an affected group (e.g. limb) results in weakness, which improves w/rest
With increased muscle weakness, reflexes decrease/disappear