Electrodiagnosis in cranial botulism

Botulism is an acute neurologic disorder that causes potentially life-threatening neuroparalysis resulting in weakness and laccid paralysis. In addition to the autonomic nervous system, botulism may involve only the cranial nerves, thus posing special diagnostic problems. Almost all cranial nerves are not easily testable. The anatomical and physiological characteristics of the spinal accessory nerve makes it very suitable to electrophysiological diagnosis of cranial botulism. Although with a working diagnosis of botulism, treatment should not be delayed pending neurophysiological tests, electrophysiological studies including spinal accessory nerve may assist in diagnostic differentiation between cranial botulism and other disorders with similar clinical presentations such as Miller-Fisher and myasthenia gravis.