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You are seeing a 9 year old boy who returned from a camping trip in Colorado 6 days ago. He had some vague complaints of paresthesias, myalgias, and general fatigue the night before. On waking this morning, he had significant bilateral lower extremity weakness and ataxia that rapidly worsened. He is afebrile. On exam, he has no patellar or Achilles deep tendon reflexes.
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October 16, 2021 at 6:19 pm
E) A tick attached to the patient
Tick paralysis is caused by neurotoxins in the tick’s saliva. The tick has typically been feeding 4-7 days by the time symptoms begin. Classic presentations include going to bed “fine” and waking with weakness, paralysis, or ataxia; deep tendon reflexes are absent. Tick paralysis is not associated with fever or rash. When suspected a thorough search for an attached tick is in order. Tick removal typically results in rapid improvement of symptoms.