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A systematic approach to evaluating neurologic symptoms includes localizing the problem anatomically and distinguishing peripheral from central etiology. Peripheral nerve disorders may affect sensory, motor, and autonomic functions (Table 146-1).

Table 146-1 Differentiating Central from Peripheral Nervous System Disorders

Botulism is caused by Clostridium botulinum toxin and occurs in 3 forms: foodborne, wound, and infantile. Foodborne botulism typically comes from improperly preserved canned foods. In infantile botulism, organisms arise from ingested spores, often in honey, and produce a systemically absorbed toxin. Clinical features appear 6 to 48 hours after ingestion and may be preceded by nausea, vomiting, and diarrhea. Wound botulism should be considered in patients with a wound or a history of intravenous drug use. Early complaints involve the eye or bulbar musculature and progress to descending weakness and respiratory insufficiency. Absent light reflex is a diagnostic clue, and mentation is normal. Infants may present with constipation, poor feeding, lethargy, and weak cry. Treatment includes respiratory support, trivalent botulinum antitoxin 10 mL IV, and admission.

Guillain-Barré syndrome (GBS) affects all ages and usually follows a viral or febrile illness, Campylobacter jejuni infection, or vaccination. Although numerous variants exist, the typical presentation includes ascending symmetric weakness or paralysis and loss of deep tendon reflexes. Respiratory failure and lethal autonomic fluctuations may occur. Cerebrospinal fluid (CSF) analysis typically shows high protein and a normal cell count (Table 146-2). Initial treatment includes respiratory support, admission to a monitored setting, and neurologic consultation.

Table 146-2 Diagnostic Criteria for Classic Guillain-Barré Syndrome

Carpal tunnel syndrome, resulting from compression of the median nerve at the wrist, classically causes pain, paresthesias, and numbness in the distribution ...

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