Tick Paralysis

Even More Paralysis

Step 1: View clinicals

A 38 year old man presents with generalized weakness and an unsteady gait for 1 day, in a background of anorexia, nausea and vomiting for 2 days. There was no history of fever, headache, or trauma. Five days ago, he returned from a visit to Queensland, Australia, where he went hiking in the bush for several days. His medical history is unremarkable. He is not on any drugs and denies substance abuse.


Step 2: Order all relevant investigations

Electrodiagnostic Studies U/L

Compound muscle action potentials are diminished in both radial and ulnar nerves. Nerve conduction velocities are within normal limits, with a normal response to repetitive stimulation.

CSF Analysis

The CSF analysis is within normal parameters.

MRI Spine

The MRI scan of the spine appears completely normal.

Botulism Workup

A botulinum toxin screen of stools and serum is performed; results will be available in 2 days. Stool cultures for C. botulinum are obtained; results will be available in 2 weeks.


Step 3: Select appropriate management

Remove Tick
Doxycycline
Plasmapheresis
Tick Anti-Venom


Score: ★★☆