Features required for diagnosis | Four clinical patterns described |
1. Progressive weakness of more than one limb | 1. Paresthaesia and flaccid weakness confined to bitten extremity |
2. Areflexia | 2. Quadriplegic form |
3. Resembling transverse myelitis |
4. Symmetrical ascending paralysis like GBS |
Clinical features supportive of diagnosis |
1. Progression over days to 1–4 weeks | 1. More rapid progression |
2. Relative symmetry of neurological deficits | 2. The extremity with the bite may be more affected |
3. Mild sensory symptoms or signs | 3. Severe paraesthesia, fasciculation and myoedema in the extremity with bite |
4. Recovery beginning 2–4 weeks after progression ceases | 4. Rapidly progressive course with eventual CNS involvement and death; hydrophobia or aerophobia is pathognomonic if present |
5. Absence of fever at onset | 5. Fever is common, during prodromal phase |
6. Cranial nerve involvement does occur | 6. Cranial nerve involvement common as in GBS |
7. Autonomic dysfunction common | 7. Autonomic dysfunction is common as in GBS |
Laboratory features supportive of diagnosis |
1. Elevated cerebrospinal fluid protein with <10 cells | 1. Elevated cerebrospinal fluid protein with varying pleocytosis |
2. Electrodiagnostic features of nerve conduction slowing or block | 2. Peripheral nerve demyelination or axonal degeneration |