Descending Paralysis From a Sealed Jar - Neurology & Neurosurgery clinical simulation case. A 34-year-old previously healthy male presents to the...
Age: 34 • Gender: Male • Setting: Emergency Triage
Clinical Presentation & History
A 34-year-old previously healthy male presents to the Emergency Department with progressive bilateral blurred vision, drooping eyelids, slurred speech, and descending weakness beginning in the shoulders and worsening over six hours. Family reports he ate home-preserved vegetables from a sealed jar approximately 18 hours prior with his brother, who is also symptomatic.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
Source Containment, Public Health Notification & Definitive Disposition
High-Yield Clinical Pearls
Foodborne botulism is a clinical diagnosis: descending flaccid paralysis with cranial-nerve onset (diplopia, ptosis, dysphagia, dysarthria) plus autonomic features after home-preserved food exposure.
Heptavalent botulinum antitoxin (BAT) must be requested as soon as the syndrome is recognized — do not wait for EMG, mouse bioassay, or stool culture results.
Aminoglycosides (gentamicin, tobramycin) and clindamycin worsen neuromuscular blockade and should be avoided.
Pre-emptive intubation is indicated when FVC < 25–30 mL/kg or NIF less negative than -25 to -30 cmH2O; emergent intubation in a botulism patient with ileus and pooled secretions is extremely high risk.
Anaphylactoid reactions to equine-derived antitoxin are managed by slowing the infusion and treating with epinephrine, antihistamines, and corticosteroids — antitoxin should usually be resumed.
Botulism is a notifiable disease; public health must be contacted immediately to retrieve suspected food, identify exposed persons, and coordinate stockpile antitoxin allocation.
Discharge criteria require sustained normalization of FVC, NIF, and autonomic stability, often weeks after onset for severe cases.
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