A 30 year old woman presents with double vision, difficulty in swallowing, difficulty in speaking, and a dry mouth for 1 day, in a background of episodic nausea and vomiting for 2 days.

Close questioning reveals a history of eating out 2 days ago along with 3 friends, one of whom was admitted to another hospital with similar symptoms just today.

There is no history of alcohol abuse, recreational drug use or snake bite. Her medical and family histories are completely unremarkable.