Acute onset of blurred vision and absent pupillary response with rapidly progressive descending muscular weakness manifesting as quadriparesis in an afebrile 20 year old male with preserved sensorium is

Answer is B (Botulism): Sudden onset of blurred vision, absent pupillary reflexes (fixed /dilated pupil with lack of accomodation), symmetric descending paralysis progressing to qudriparesis and preserved sensorium suggest a diagnosis of Botulism. Cardinal Feature of Botulism Cranial Nerve Palsies with prominent bulbar palsy (4 'D's of Bulbar Palsy) (Diplopia, Dysahria, Dysphonia, Dysphagia, Ptosis, Loss of Accomodation, Fixed / Dilated pupils) Descending motor paralysis (Extent of paralysis from a few cranial nerves only to quadriperesis depends on dose of toxin) Symmetry of symptoms/signs A clear sensorium Absence of fever Lack of sensory findings