Descending Paralysis: Ascending the Path to Diagnosis

Acute diffuse weakness beginning in the bulbar region and progressing to paralysis can have several causes, and often the history and physical exam lead to the diagnosis. This article discusses several diseases that can cause acute paralysis, including the key signs and symptoms, diagnostic test, and treatment. Selected toxins that can cause paralysis also are reported on. Particular focus is given to one case of a patient who presents to the ED with rapidly descending paralysis.