{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:34:26Z","timestamp":1768782866716,"version":"3.49.0"},"reference-count":9,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2018,6,26]]},"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:p>A 42-year-old man, returning to Europe after a 2-month stay in China, reported cough and runny nose. Five days later, he developed neck discomfort and rapidly evolving weakness, spreading from his arms to the facial, bulbar and neck muscles, and then the legs. He developed dysphagia and breathlessness, and was intubated in the emergency department. Cerebrospinal fluid showed mildly elevated protein. On day 2 he had fixed dilated pupils, with absent oculocephalic reflexes, and a flaccid upper limb paralysis. MR scans of the brain and spinal cord were normal. The early features of descending weakness, bulbar involvement and fixed dilated pupils made it difficult to distinguish between Guillain-Barr\u00e9 syndrome and botulism, and early investigations were inconclusive. We initially gave both botulinum antitoxin and intravenous immunoglobulin, but initially delayed plasma exchange as this would have removed the botulinum antitoxin. Diagnostic testing for botulism has low sensitivity, so we urge pre-emptive treatment if it is clinically suspected.<\/jats:p>","DOI":"10.1136\/practneurol-2018-001891","type":"journal-article","created":{"date-parts":[[2018,7,30]],"date-time":"2018-07-30T12:19:51Z","timestamp":1532953191000},"page":"501-504","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Guillain-Barr\u00e9 syndrome mimicking botulism in early disease course"],"prefix":"10.1136","volume":"18","author":[{"given":"Robert","family":"Durcan","sequence":"first","affiliation":[{"name":"Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland"},{"name":"Dublin Neurological Institute, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olwen","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland"},{"name":"Dublin Neurological Institute, Dublin, Ireland"},{"name":"Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Lynch","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland"},{"name":"Dublin Neurological Institute, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,30]]},"reference":[{"key":"2025090411553000000_18.6.501.1","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.ncl.2013.01.005","article-title":"Guillain-Barr\u00e9 syndrome and variants","volume":"31","author":"Dimachkie","year":"2013","journal-title":"Neurol Clin"},{"key":"2025090411553000000_18.6.501.2","doi-asserted-by":"publisher","DOI":"10.1086\/444507"},{"key":"2025090411553000000_18.6.501.3","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2014-000937"},{"key":"2025090411553000000_18.6.501.4","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-129-3-199808010-00011"},{"key":"2025090411553000000_18.6.501.5","doi-asserted-by":"publisher","DOI":"10.1097\/00004691-199304000-00004"},{"key":"2025090411553000000_18.6.501.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199204233261706"},{"key":"2025090411553000000_18.6.501.7","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awt285"},{"key":"2025090411553000000_18.6.501.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-008-0775-0"},{"key":"2025090411553000000_18.6.501.9","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-305397"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/practneurol-2018-001891","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T18:55:40Z","timestamp":1757012140000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/practneurol-2018-001891"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,30]]},"references-count":9,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,11,16]]},"published-print":{"date-parts":[[2018,12]]}},"alternative-id":["10.1136\/practneurol-2018-001891"],"URL":"https:\/\/doi.org\/10.1136\/practneurol-2018-001891","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,30]]}}}