Raw salmon or red herring: ascending paralysis with suspected seafood poisoning

Naren Gunja, Robert P Dowsett and Karl Ng
Med J Aust 2007; 187 (8): . || doi: 10.5694/j.1326-5377.2007.tb01359.x
Published online: 15 October 2007

A 16-year-old boy presented with rapidly progressive ascending paralysis 1 hour after eating raw salmon. Seafood poisoning was initially considered. Although salmon is not a common cause of toxic seafood poisoning, cases have been reported in the Pacific region. The patient rapidly developed acute left heart and respiratory failure, and investigations revealed a rare tracking intramedullary haematoma of the spinal cord. Structural abnormalities of the central nervous system may present with acute paralysis and spinal shock, mimicking toxicological syndromes.

A 16-year-old boy presented to the emergency department with severe epigastric pain, headache and ascending lower limb weakness 1 hour after eating raw salmon. The weakness ascended rapidly over the next hour to involve the upper limbs. In hospital, he was alert, but was soft-voiced and in obvious respiratory distress. He had tachycardia (heart rate, 110 beats per min), hypertension (blood pressure, 205/128 mmHg), tachypnoea (22 breaths per min) and oxygen saturation of 89% (using a non-rebreathing oxygen mask). Although his sensation and mental state appeared normal, he had profound quadriparesis. Pupils were 3 mm in diameter, equal and sluggishly reactive to light. Because of a rapid deterioration in his respiratory status, the patient was intubated, ventilated, and sedated with a propofol infusion before a more complete neurological examination could be completed.

  • 1 Emergency Department, Westmead Hospital, Sydney, NSW.
  • 2 NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, NSW.
  • 3 Faculty of Medicine, University of Sydney, Sydney, NSW.
  • 4 Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW.
  • 5 Royal North Shore Hospital, Sydney, NSW.


We thank Dr D Brazier and Dr J Brewer, Royal North Shore Hospital, for the magnetic resonance image and histopathological image, respectively.

Competing interests:

None identified.

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