A 6-YEAR-OLD girl in Georgia developed paresthesias and leg weakness with unstable gait that worsened over several hours.1 Under hospital observation for 2 days, she became progressively weaker in the lower and later upper extremities, areflexic, and ataxic (Figure 1). Sensory testing results were normal. Findings from neuroimaging and cerebrospinal fluid studies were normal. Nerve conduction studies revealed slowing of conduction velocities and marked reduction in the amplitude of muscle action potential without impairment of neuromuscular transmission. Reduction in vital capacity with hypoxia, lethargy, slurred speech, and bilateral ptosis necessitated transfer to the intensive care unit for plasmapheresis and possible intubation for presumed Guillain-Barré syndrome. With the aid of a fine-toothed comb, a physician detected an engorged tick embedded in the patient's posterior scalp (Figure 2). The specimen was removed and identified as a female Dermacentor variabilis. Within 6 hours, bulbar signs, and hypoventilation resolved and strength improved. The child recovered completely within 24 hours. Results of follow-up nerve conduction studies were normal. Seventeen days after removal, the tick oviposited approximately 200 eggs (Figure 3).
Felz MW, Swift TR, Hobbs W. Tick Paralysis in the United States: A Photographic Review. Arch Neurol. 2000;57(7):1071-1072. doi:10.1001/archneur.57.7.1071