So let's learn a
little bit about,
infectious causes of
neuromuscular junction disorders
and botulism toxin,
Botulism is a toxin,
it is a type of infection.
Patients who ingest this toxin,
present with proximal weakness.
This begins in the eye muscles
typically, involves autonomic fibers
and then progresses to
include generalized weakness.
That bulbar initiation
is very important,
because that's different from other
neuromuscular junction conditions.
In addition, we see that botulism involves
the extraocular movements and autonomics
and myasthenia gravis
really does not.
So these are important differentiating
details on both the history
and the physical exam that will guide us in
the direction of the appropriate diagnosis.
There are two types of
patients that may present
with botox toxicity
or botulism toxicity.
The first is iatrogenic as in this
case and this has become more common,
though it's a rare
complication of this treatment
but more common with
the widespread use of
botulism toxin to treat patients
who have certain disorders.
This patient had increased tone
and a limb and was undergoing
limb treatment for limb
spasticity or limb rigidity.
The patient received multiple injections
of botulism toxin into the muscle
to result to decrease the tone in
that muscle and improve movement,
and this is not an uncommon dose
or way to treat these patients.
In rare cases,
patients will develop systemic
botulism toxicity as a result
of that localized treatment.
Just as was the case
for our patient.
The other presentation is
the floppy baby syndrome,
and this is commonly tested
not as commonly encountered
but it is something that
you should know about.
This is typically a young child that presents
with hypotonia decreased muscle tone,
and you can see the baby in this picture
and here has reduced tone is unable
to keep their normal body structure
and tone with the examination.
The patient appears floppy,
this is a floppy baby syndrome
and this results from
ingesting the botox toxin,
which is commonly contained in
certain foods and substances
and in test questions, we often hear
that there is an ingestion of honey.
And the botox toxin is contained
within the honey and with ingestion,
a young child or infant
can present with hypotonia.