Abstract
Neurologists are most likely to become involved in primarily diagnosing those bioterrorist
attacks utilising botulinum toxin. Oral ingestion, or possibly inhalation, are likely
routes of delivery. The characteristic descending paralysis starts in the extraocular
and bulbar muscles, with associated autonomic features. Repetitive nerve stimulation
usually shows an incremental muscle response. Treatment is supportive. The differential
diagnosis is from naturally occurring paralysing illnesses such as Guillain–Barré
syndrome, myasthenic crisis or diphtheria, from paralysing seafood neurotoxins (tetrodotoxin,
saxitoxin), snake envenomation, and from chemical warfare poisoning by organophosphates.
Primary neurological infections are less feasible for use as bioweapons. There are
theoretical possibilities of Venezuelan equine encephalitis transmission by inhalation
and secondary zoonotic transmission cycles sustained by horses and mosquitoes. Severe
haemorrhagic meningitis regularly occurs in anthrax, usually in the aftermath of severe
systemic disease likely to have been transmitted by spore inhalation.
Panic and psychologically determined ‘me-too’ symptomatology are likely to pose the
biggest diagnostic and management burden on neurologists handling bioterrorist attack
on an institution or a random civilian population. Indeed civilian panic and disablement
of institutional operations are likely to be prominent intentions of any bioterrorist
attack.
Keywords
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