unrelated cases of tick paralysis: onset of prominent bulbar palsies; ascending paralysis

1: Pediatr Emerg Care. 2005 Oct;21(10):677-80. Related Articles, Links



Tick paralysis: atypical presentation, unusual location.

Daugherty RJ, Posner JC, Henretig FM, McHugh LA, Tan CG.

Department of Pediatrics The Children's Hospital of Philadelphia,
University of Pennsylvania School of Medicine, Philadelphia, PA 19104,
USA. daugherty@xxxxxxxxxxxxxx

We present 2 unrelated cases of tick paralysis presenting within a
2-month period in the greater Philadelphia region, a geographic area in
which this disease is highly unusual. Our first patient demonstrated
early onset of prominent bulbar palsies, an atypical presentation. Our
second patient, residing in a nearby but distinct community, presented
with ascending paralysis 2 months after the first. The atypical
presentation of our first patient and the further occurrence within a
few months of a second patient, both from the Northeastern United
States where this diagnosis is rarely made, suggest the need to
maintain a high index of suspicion for this disease in patients
presenting with acute onset of cranial nerve dysfunction or muscle
weakness. Through simple diagnostic and therapeutic measures (ie,
careful physical examination to locate and remove the offending tick),
misdiagnosis and unnecessary morbidity can be avoided.

PMID: 16215474 [PubMed - in process]

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