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Case Files Neurology - part 6

Điều trị với thuốc kháng độc. Các globulin miễn dịch botulinum ở trẻ sơ sinh đã được chứng minh để rút ngắn thời gian nằm viện và chi phí nằm viện. Thêm vào đó nó đã được chứng minh là làm giảm mức độ nghiêm trọng của bệnh. | CLINICAL CASES 233 Treatment Treatment is with antitoxin. The botulinum immunoglobulin in infants has been shown to shorten the hospital stay and cost of hospitalization. Additionally it has been shown to reduce the severity of illness. Human botulinum immunoglobulin is directed toward type A and B. Supportive care is vital. Patient should be carefully monitored in an ICU setting for impending respiratory distress. Additionally tube feedings and care for the prolonged immobility and stress ulcers are needed. The case fatality rate is less than 2 on average infants will spend 44 days in the hospital. Rare cases of relapse have been reported with no known predictors identified. Most relapses occur within 2 weeks of being discharged from the hospital. Comprehension Questions 27.1 A 2-month-old baby boy presents with a history of poor suck irritability decreased oral intake ptosis head drop and weakness in the arms and legs. The baby is in foster care and there is not a good way to obtain a history. While evaluating the baby he develops respiratory distress. Key findings on his examination include external ophthalmoplegia reactive pupils ptosis facial weakness and weakness in the arms and legs. His DTRs and tone appear to be normal. What is the likely diagnosis A. Infantile botulism B. Neonatal myasthenia gravis C. Guillain-Barré syndrome D. Meningitis 27.2 In cases of suspected infantile botulism which of the following is the most helpful in evaluating the patient A. Serum test for botulinum toxin B. CSF studies for botulinum toxin C. EMG with repetitive nerve stimulation studies D. Pharyngeal culture for botulinum toxin 27.3 A 73-year-old man presents to the emergency room complaining of diplopia blurred vision dysphagia and xerostomia. His examination reveals ptosis impaired ocular motility dilated pupils symmetrical weakness in the arms and legs and normal cognitive function. Which of the following would be most consistent with his presentation A. Antecedent .