title: Long lasting dysautonomia due to botulinum toxin B poisoning: clinical-laboratory follow up and difficulties in initial diagnosis.
abstract: BACKGROUND
  Botulism is an acute form of poisoning caused by one of four types (A, B, E, F) toxins produced by Clostridium botulinum, ananaerobic, spore forming bacillus. Usually diagnosis of botulism is considered in patients with predominant motor symptoms: muscle weakness with intact sensation and preserved mental function.
  
  
  METHODS
  We report a case of 56-year-old Caucasian female with a history of arterial hypertension, who presented with acute respiratory failure and bilateral ptosis misdiagnosed as brainstem ischemia. She had severe external and internal ophtalmoplegia, and autonomic dysfunction with neither motor nor sensory symptoms from upper and lower limbs. Diagnosis of botulinum toxin poisoning was made and confirmed by serum antibody testing in the mouse inoculation test.
  
  
  CONCLUSIONS
  Ophtalmoplegia, autonomic dysfunction and respiratory failure can be caused by botulism. Early treatment and intensive care is essential for survival and recovery. The electrophysiological tests are crucial to correct and rapid diagnosis. Botulism (especially type B) should be considered in any case of acute or predominant isolated autonomic dysfunction.
authors.affiliation: Department of Neurology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland. apotulska@wum.edu.pl.
authors.forename: Anna
authors.initials: A
authors.lastname: Potulska-Chromik
authors.forename: Beata
authors.initials: B
authors.lastname: Zakrzewska-Pniewska
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Szmidt-Sałkowska
authors.forename: Jacek
authors.initials: J
authors.lastname: Lewandowski
authors.forename: Maciej
authors.initials: M
authors.lastname: Siński
authors.forename: Witold
authors.initials: W
authors.lastname: Przyjałkowski
authors.forename: Anna
authors.initials: A
authors.lastname: Kostera-Pruszczyk
mesh_terms: D000328:Adult; D000818:Animals; D001905:Botulinum Toxins / Q000506:poisoning*; D001906:Botulism / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology; D003014:Clostridium botulinum / Q000472:pathogenicity*; D003937:Diagnosis, Differential; D005260:Female; D006732:Horner Syndrome / Q000503:physiopathology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000503:physiopathology; D051379:Mice; D018908:Muscle Weakness / Q000503:physiopathology; D054969:Primary Dysautonomias / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology; D012131:Respiratory Insufficiency / Q000503:physiopathology; D013997:Time Factors
chemical_list: D001905:Botulinum Toxins