Tick paralysis: Difference between revisions
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==Background== | ==Background== | ||
*Caused by neurotoxin produced by certain ticks in the US and Australia | *Caused by neurotoxin produced by certain ticks (e.g. ''Ixodes holocyclus'') in the US and Australia | ||
*Most cases reported in children | *Most cases reported in children | ||
==Pathophysiology== | |||
Paralysis results from the neurotoxin “ixobotoxin,” which inhibits the release of acetylcholine at | |||
the neuromuscular junction and autonomic ganglia, very similar to botulinum toxin. | |||
==Clinical Features== | ==Clinical Features== | ||
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==Treatment== | ==Treatment== | ||
*Remove tick as quickly as possible with tweezers | *Remove tick as quickly as possible with tweezers | ||
**Removal of Ixodes tick does not result in improvement for days to weeks. | |||
*Supportive care (resolves on its own) | *Supportive care (resolves on its own) | ||
Revision as of 01:06, 17 November 2015
Background
- Caused by neurotoxin produced by certain ticks (e.g. Ixodes holocyclus) in the US and Australia
- Most cases reported in children
Pathophysiology
Paralysis results from the neurotoxin “ixobotoxin,” which inhibits the release of acetylcholine at the neuromuscular junction and autonomic ganglia, very similar to botulinum toxin.
Clinical Features
- Symptoms begin 2-6d after attachment of tick
- Ataxia -> symmetric ascending flaccid paralysis w/ loss of DTRs
- Presentation can be identical to Guillain-Barre including progression to resp paralysis
- Unlike GBS, may have ocular signs (e.g. fixed and dilated pupils)
Differential Diagnosis
Tick Borne Illnesses
- Babesiosis
- Colorado tick fever
- Ehrlichiosis
- Heartland virus
- Lyme
- Murine typhus
- Rocky mountain spotted fever
- Southern tick-associated rash illness (STARI)
- Tick paralysis
- Tularemia
Weakness
- Neuromuscular weakness
- Upper motor neuron:
- CVA
- Hemorrhagic stroke
- Multiple sclerosis
- Amyotrophic Lateral Sclerosis (ALS) (upper and lower motor neuron)
- Lower motor neuron:
- Spinal and bulbar muscular atrophy (Kennedy's syndrome)
- Spinal cord disease:
- Infection (Epidural abscess)
- Infarction/ischemia
- Trauma (Spinal Cord Syndromes)
- Inflammation (Transverse Myelitis)
- Degenerative (Spinal muscular atrophy)
- Tumor
- Peripheral nerve disease:
- Neuromuscular junction disease:
- Muscle disease:
- Rhabdomyolysis
- Dermatomyositis
- Polymyositis
- Alcoholic myopathy
- Upper motor neuron:
- Non-neuromuscular weakness
- Can't miss diagnoses:
- ACS
- Arrhythmia/Syncope
- Severe infection/Sepsis
- Hypoglycemia
- Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
- Respiratory failure
- Emergent Diagnoses:
- Symptomatic Anemia
- Severe dehydration
- Hypothyroidism
- Polypharmacy
- Malignancy
- Aortic disease - occlusion, stenosis, dissection
- Other causes of weakness and paralysis
- Acute intermittent porphyria (ascending weakness)
- Can't miss diagnoses:
Diagnosis
- Sensory abnormalities and elevation of CSF protein level do not occur
- Progression and resolution of sx (w/ tick removal) is faster than in Guillain-Barre
Treatment
- Remove tick as quickly as possible with tweezers
- Removal of Ixodes tick does not result in improvement for days to weeks.
- Supportive care (resolves on its own)