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Good RJ, Messacar K, Stence NV, et al. Abnormal Neuroimaging in a Case of Infant Botulism. Front Pediatr. 2015;3:108doi: 10.3389/fped.2015.00108.
Good, R. J., Messacar, K., Stence, N. V., Press, C. A., & Carpenter, T. C. (2015). Abnormal Neuroimaging in a Case of Infant Botulism. Frontiers in pediatrics, 3108. https://doi.org/10.3389/fped.2015.00108
Good, Ryan J, et al. "Abnormal Neuroimaging in a Case of Infant Botulism." Frontiers in pediatrics vol. 3 (2015): 108. doi: https://doi.org/10.3389/fped.2015.00108
Good RJ, Messacar K, Stence NV, Press CA, Carpenter TC. Abnormal Neuroimaging in a Case of Infant Botulism. Front Pediatr. 2015 Dec 11;3:108. doi: 10.3389/fped.2015.00108. eCollection 2015. PMID: 26697417; PMCID: PMC4676149.
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Front Pediatr. 2015 Dec 11;3:108. doi: 10.3389/fped.2015.00108. eCollection 2015.

Abnormal Neuroimaging in a Case of Infant Botulism.

Frontiers in pediatrics

Ryan J Good, Kevin Messacar, Nicholas V Stence, Craig A Press, Todd C Carpenter

Affiliations

  1. Pediatric Critical Care Medicine, University of Colorado - Denver , Aurora, CO , USA.
  2. Pediatric Infectious Disease, University of Colorado - Denver , Aurora, CO , USA.
  3. Pediatric Neuroradiology, University of Colorado - Denver , Aurora, CO , USA.
  4. Pediatric Neurology, University of Colorado - Denver , Aurora, CO , USA.

PMID: 26697417 PMCID: PMC4676149 DOI: 10.3389/fped.2015.00108

Abstract

We present the first case of abnormal neuroimaging in a case of infant botulism. The clinical findings of the patient with constipation, bulbar weakness, and descending, symmetric motor weakness are consistent with the classic findings of infant botulism. Magnetic resonance imaging (MRI), however, revealed restricted diffusion in the brain and enhancement of the cervical nerve roots. Traditionally, normal neuroimaging was used to help differentiate infant botulism from other causes of weakness in infants. Abnormal neuroimaging is seen in other causes of weakness in an infant including metabolic disorders and hypoxic-ischemic injury, but these diagnoses did not fit the clinical findings in this case. The explanation for the MRI abnormalities in the brain and cervical nerve roots is unclear as botulinum toxin acts at presynaptic nerve terminals and does not cross the blood-brain barrier. Possible explanations for the findings include inflammation from the botulinum toxin at the synapse, alterations in sensory signaling and retrograde transport of the botulinum toxin. The patient was treated with human botulism immune globulin and had rapid recovery in weakness. A stool sample from the patient was positive for Type A Clostridium botulinum toxin eventually confirming the diagnosis of infant botulism. The findings in this case support use of human botulism immune globulin when the clinical findings are consistent with infant botulism despite the presence of MRI abnormalities in the brain and cervical nerve roots.

Keywords: acute flaccid paralysis; human botulism immune globulin; infant botulism; neuroimaging; toxin

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