Table 1

Acute neurological symptoms and signs seen by ciguatera victims

Symptom Notes
Paraesthesiae3 4 One of the first signs of ciguatera intoxication.37 Occurs within hours of toxic fish ingestion. Symptoms last for days or weeks. Centrifugal spread from circumoral and glossal focus.
Dysaesthesiae3 4 26 A combination of hyperaesthesia; heightened nociperception; peripheral dysaesthesiae with possible central element of perverted sensation.
Other sensory signsMetallic taste,37pruritus,40 arthralgia, and myalgia.
PainLimb,3 skin, joints,3dental,26 37 and urethral.18
Headache3 4 10 May be a presenting sign. Usually non-localised; may be intense and prolonged.
Weakness3 10 Both peripherial features often with central accentuation due to prostration.
Autonomic signsHypersalivation, bradycardia, laryngeal spasm, hypotension, mydriasis, or meiosis.
Sensory signs18 27 Insomnia, vertigo, nightmares (especially zoopsia40), coma,15 convulsions.
Motor symptoms and signs27 Weakness16 (due to both neural involvement34) and polymyositis,35 36hyporeflexia; dysphagia, paresis.
Cerebellar signs and tremorSometimes late presenting; may occur up to 10 days after initial intoxication.30 31