Tick paralysis: Difference between revisions
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**Ataxia -> symmetric ascending flaccid paralysis w/ loss of DTRs | **Ataxia -> symmetric ascending flaccid paralysis w/ loss of DTRs | ||
*Presentation can be identical to Guillain-Barre including progression to resp paralysis | *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 DDX}} | |||
{{Weakness DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
*Sensory abnormalities and elevation of CSF protein level do not occur | *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 | *Progression and resolution of sx (w/ tick removal) is faster than in Guillain-Barre | ||
==Treatment== | ==Treatment== | ||
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*Supportive care (resolves on its own) | *Supportive care (resolves on its own) | ||
== | ==References== | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 13:54, 20 July 2015
Background
- Caused by neurotoxin produced by certain ticks in the US and Australia
- Most cases reported in children
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
- Supportive care (resolves on its own)