Nokea
In the morning a patient had nausea, abdominal discomfort, single vomiting, dry mouth. In the evening, the patient presented with the increasing general weakness, double vision, difficult swallowing of solid food. Objectively: ptosis, mydriasis, anisocoria, absence of gag and pharyngeal reflex, dry mucous membranes. The previous evening the patient had dinner with canned food and alcohol. What is the presumptive diagnosis?
Correct Answer: A
Rationale: The correct answer is A: Botulism. The symptoms described, such as ptosis, mydriasis, anisocoria, dry mouth, and absent gag reflex, are classic signs of botulism. Botulism is caused by the bacterium Clostridium botulinum, commonly found in improperly preserved canned foods. The progression from gastrointestinal symptoms to neurological symptoms, like double vision and difficulty swallowing, is characteristic of botulism due to the toxin's effect on neuromuscular transmission. Poliomyelitis primarily affects the motor neurons and presents with different symptoms. Food toxicoinfection typically involves gastrointestinal symptoms and does not manifest with the neurological findings seen in this case. Acute ischemic stroke presents with sudden onset neurological deficits due to impaired blood flow to the brain, which is not consistent with the gradual progression of symptoms in this scenario.