Differential Diagnosis for Respiratory Muscle Paralysis with Neck Extensors Paralysis

• Single most likely diagnosis:
  • Guillain-Barré Syndrome: This is an autoimmune disorder that often presents with ascending paralysis, which can include respiratory muscle paralysis and neck extensor paralysis. The condition typically follows a minor infection and can progress rapidly, making it a critical diagnosis to consider.
• Other Likely diagnoses:
  • Myasthenia Gravis: An autoimmune disease characterized by muscle weakness that worsens with activity and improves with rest. It can affect any muscle group, including respiratory and neck muscles, leading to paralysis.
  • Botulism: A rare but serious illness caused by a toxin produced by the bacteria Clostridium botulinum. It can lead to muscle weakness, paralysis, and respiratory failure, including paralysis of the neck extensors.
  • Spinal Cord Injury: Trauma to the spinal cord can result in paralysis of muscles below the level of the injury, including respiratory muscles and neck extensors, depending on the location and severity of the injury.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Poliomyelitis: Although rare in areas with widespread vaccination, polio can cause acute flaccid paralysis, including respiratory failure and paralysis of neck extensors. Missing this diagnosis could have severe consequences.
  • Tetanus: Caused by the toxin of Clostridium tetani, tetanus can lead to muscle rigidity and spasms, including of the respiratory and neck muscles, which can be life-threatening if not promptly treated.
  • Diphtheria: A bacterial infection that can cause a membrane to form over the tonsils and throat, leading to respiratory obstruction, and in severe cases, paralysis of respiratory and other muscles due to the toxin produced.
• Rare diagnoses:
  • Tick Paralysis: A rare condition caused by the neurotoxin in the saliva of certain ticks, which can lead to ascending paralysis, including respiratory muscle paralysis.
  • Lambert-Eaton Myasthenic Syndrome (LEMS): An autoimmune disorder that can cause muscle weakness, including of the respiratory and neck muscles, though it is less common than myasthenia gravis and often associated with small cell lung cancer.