A Case of Subacute Ataxia in the Summertime: Tick Paralysis

Journal of General Internal Medicine
Christin B Laufer, Nicole Chiota-McCollum

Abstract

Tick paralysis is caused by a neurotoxin secreted in the saliva of a gravid female tick, and manifests with ataxia, areflexia, ascending paralysis, bulbar palsy, and ophthalmoparesis. An 84-year-old man presented in June in coastal Mississippi with several days of subacute ataxia, bulbar palsy, unilateral weakness, and absent deep tendon reflexes. MRI/MRA and extensive serum and cerebrospinal fluid investigations were unrevealing. His symptoms progressed over several days, until his nurse discovered and removed an engorged tick from his gluteal fold. Within hours of tick removal, his subacute symptoms completely resolved. While tick paralysis is rare in adults, it is a condition that internists should be familiar with, particularly in seasons and areas with high prevalence of disease. This case also highlights the importance of performing a thorough skin exam on patients with the aforementioned neurologic abnormalities.

References

Jan 13, 2000·The New England Journal of Medicine·M W FelzT R Swift
Jul 17, 2004·Seminars in Neurology·V VedanarayananS H Subramony
Jul 21, 2010·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·R GalvinUNKNOWN EFNS

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Citations

May 25, 2016·Neurology. Neuroimmunology and Neuroinflammation·Cynthia CarterJack W Tsao
Oct 31, 2017·Vector Borne and Zoonotic Diseases·Muhammad MorshedQuantine Wong

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