An 18 year old male presented with acute onset descending paralysis of 3 days duration. There is also a history of blurring of vision for the same duration. On examination, the patient has quadriparesis with areflexia. Both the pupils are non-reactive. The most probable diagnosis is:

Diagnosis of botulism should be considered in patient with symmetric descending paralysis with bilateral cranial neuropathies in addition of following features: Absent fever Patient remains responsive Heart rate normal or slow Sensory deficit doesn’t occur except for blurred vision. Remember: Neurologic signs and symptom of botulism: Dysphagia Dry mouth Diplopia Dysarthria Upper limb weakness Lower limb weakness Blurred vision Dyspnea