NEUROOPHTHALMIC FINDINGS IN BOTULISM TYPE-B

In June 1989, the largest recorded outbreak of foodborne botulism occu rred in the United Kingdom. Twenty-seven patients were affected during the outbreak with type B botulism. A case note review of 14 patients admitted with this condition was performed and the neuroophthalmic fin dings are presented. Patients with severe disease presented with a com bination of ocular and bulbar symptoms; in mild cases dysphagia was no ted first and visual disturbance followed within 24 hours. Clustering of cases and bilaterality of cranial nerve signs aided in the diagnosi s. Accommodative paresis and sixth cranial nerve palsy were frequent e arly signs. When there was respiratory paralysis and ventilatory failu re, it occurred within 12 hours of the onset of a third cranial nerve palsy.