{
    "abstract": "A man aged in his sixties presented to the emergency department with vomiting, dizziness and generalised weakness preceded by perioral and peripheral paraesthesias for several hours. He did not speak English and was visiting from overseas. Examination revealed multidirectional nystagmus, subtle bilateral ptosis, marked bilateral upper limb dysmetria and heel-shin ataxia, with mild proximal limb weakness. Brain imaging was unremarkable. Further history revealed the man had gone fishing and eaten a fish he had caught earlier that day. He was subsequently diagnosed with tetrodotoxin toxicity from pufferfish ingestion. He was managed supportively and made a complete recovery. Tetrodotoxicity has been hitherto considered rare outside of Southeast Asia, but rising water temperatures and human interventions have facilitated the migration of marine species containing tetrodotoxin to a wider geographical range.",
    "authors": [
        {
            "affiliation": "Royal Adelaide Hospital, Adelaide, South Australia, Australia emily.burton@sa.gov.au.\nThe University of Adelaide, Adelaide, South Australia, Australia.",
            "firstname": "Emily",
            "initials": "E",
            "lastname": "Burton"
        },
        {
            "affiliation": "Royal Adelaide Hospital, Adelaide, South Australia, Australia.\nWomen's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia.",
            "firstname": "Alastair",
            "initials": "A",
            "lastname": "Ward"
        },
        {
            "affiliation": "Royal Adelaide Hospital, Adelaide, South Australia, Australia.",
            "firstname": "Lachlan",
            "initials": "L",
            "lastname": "Tamlin"
        },
        {
            "affiliation": "Royal Adelaide Hospital, Adelaide, South Australia, Australia.",
            "firstname": "Shaddy",
            "initials": "S",
            "lastname": "El-Masri"
        },
        {
            "affiliation": "Royal Adelaide Hospital, Adelaide, South Australia, Australia.\nThe University of Adelaide, Adelaide, South Australia, Australia.",
            "firstname": "Rudy",
            "initials": "R",
            "lastname": "Goh"
        },
        {
            "affiliation": "Royal Adelaide Hospital, Adelaide, South Australia, Australia.\nDepartment of Genetics & Molecular Pathology, SA Pathology, Adelaide, South Australia, Australia.",
            "firstname": "Roula",
            "initials": "R",
            "lastname": "Ghaoui"
        },
        {
            "affiliation": "Department of Neurology, Flinders Medical Centre, Bedford Park, Australia.\nLyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.",
            "firstname": "Stephen",
            "initials": "S",
            "lastname": "Bacchi"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.",
    "doi": "10.1136/pn-2024-004368",
    "journal": "Practical neurology",
    "keywords": [
        "CEREBELLAR ATAXIA",
        "NEUROTOXICOLOGY",
        "RESPIRATORY MEDICINE",
        "TOXICOLOGY"
    ],
    "methods": null,
    "publication_date": "2024-12-15",
    "pubmed_id": "39674593",
    "results": null,
    "title": "Tetrodotoxin toxicity: an increasing threat.",
    "xml": "<Element 'PubmedArticle' at 0x788505db5120>"
}