case report

A previously well 13 year old boy presented with a seven hour history of increasing breathlessness, aching of his facial and neck muscles, and a rapidly progressive weakness of all four limbs. The patient had complained of a mild coryzal illness for the previous five days. The patient was afebrile and there was no evidence of rash, tick bite, or lymphadenopathy. He was ‘alert’ and his breathing pattern was shallow. Neurological examination demonstrated marked hypotonia and diffuse muscle weakness (Medical Research Council (MRC) classification grade 2); muscle stretch and abdominal reflexes were absent. Plantar responses were flexor. Extraocular eye movements were absent; there was some movement of the eyelids (MRC grade 1–2) and pupillary responses …