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An Asymmetric Onset of Neurological Signs Does Not Rule Out the Botulism

Marina Trivisano, Giuseppe d’Orsi, Adele Gianmario, Marianna Ciarallo, Maria E. Liuni, Giovanna D’Addiego, Anna Lepore, Teresa Santantonio and Luigi M. Specchio

Foodborne Botulism is clinically characterized by a symmetric flaccid paralysis of the cranial nerves with a descending involvement of voluntary and breathing muscles leading to respiratory arrest. Asymmetric neurological signs are unusual and in these cases diagnosis could be delayed or frequently missed. We described a 63-year-old man with a clinical picture related to type A botulism characterized by an asymmetric and left lateralized onset of neurological signs associated with a monolateral parotitis. Physicians must be aware that lateralized onset of neurological signs does not rule out the botulism, and it should be considered even in cases of atypical clinical picture.