A 34 year-old female presents to the emergency room for trouble walking. She reports that over the last few days, she developed slurred speech, tremors, loss of coordination and trouble eating and swallowing. Four weeks ago, she went to Hawaii and ‘feasted on lots of barracuda and grouper’. Within a few minutes after the dinner, she developed diarrhea, vomiting and abdominal cramps. She developed ‘pins and needles’ sensations, first around her mouth and later in her limbs. She reports that her taste sensations ‘turned upside down’, like ‘ice cream feels like hot coffee and hot coffee feels like ice cream’. She developed an itching rash all over her body. Thinking she had an allergic reaction to food, she took, ‘tons of Benadryl which did nothing’ to alleviate her symptoms. She feels muscles ache with ‘shooting pains all over’. Her diarrhea, vomiting and abdominal cramps got better within a few days, but the burning sensations in the feet and tremors in hands and feet are still bothering her. She feels dizzy and her surroundings feel like spinning around her. Sometimes she hears sounds and voices nobody else hears. Vital signs: Temp = 98.9 F, BP = 80/60 mm Hg, Pulse = 54/minute, RR = 22/minute What is the most likely diagnosis in this patient?
