Tick Paralysis

7 Aug

Presentation

First 24 hours = reslesness, irritatbility, fatigue, paresthesias, myalgias

2-6 days tost tick attachment = unsteady gait, decreased deep tendon reflexes progressing to acute symmetric ascending flaccid paralysis.

*may involve cranial nerves: drooling, dysphagia, dysphonia, facial weakness

*involvement of respiratory muscles can lead to trouble without ventialtory support

 

Differential Diagnosis

Botulism, Guillain-Barre Syndrome, Myasthenia gravis, Lambert-Eaton syndrome, transverse myelitis, spinal cord compression, heavy metal poisoning, organophosphate poisoning

 

Risk Factors

Girls with long hair, < 8 years of age, spring and summer months.

Geography (Dermacentor andersoni: rocky mountain region, pacific northwest, southwest, Canada; Dermacentor variabilis: southeast; Ixodes holyclus: Australia)

 

Pathophysiology

The tick’s salivary glands produce a neurotoxin believed to decrease the presynaptic acetylcholine release at the neuromuscular junction (similar to botulinum toxin)

 

Diagnosis

Clinical findings + engorged tick

 

Treatment

Remove the tick! (duh)

Dermacentor ticks -> symptoms improve shortly after removal

Ixodes ticks -> symptoms may persist 1-2 days after removal

 

Submitted by Kelly Estes.

 

References:

Taraschenko OD1, Powers KM2. Neurotoxin-induced paralysis: a case of tick paralysis in a 2-year-old child. Pediatr Neurol. 2014 Jun;50(6):605-7. PMID: 24679414.

Chagnon SL1, Naik M, Abdel-Hamid H. Child neurology: tick paralysis: a diagnosis not to miss. Neurology. 2014 Mar 18;82(11):e91-3. PMID: 24638220.

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