Taraschenko Olga D, Powers Karen M
Department of Neurology, Albany Medical College, Albany, New York.
Department of Neurology, Albany Medical College, Albany, New York.
Pediatr Neurol. 2014 Jun;50(6):605-7. doi: 10.1016/j.pediatrneurol.2014.01.041. Epub 2014 Jan 24.
Tick paralysis is an arthropod-transmitted disease causing potentially lethal progressive ascending weakness. The presenting symptoms of tick paralysis overlap those of acute inflammatory diseases of the peripheral nervous system and spinal cord; thus, the condition is often misdiagnosed, leading to unnecessary treatments and prolonged hospitalization.
A 2-year-old girl residing in northern New York and having no history of travel to areas endemic to ticks presented with rapidly progressing ascending paralysis, hyporeflexia, and intact sensory examination. Investigation included blood and serum toxicology screens, cerebrospinal fluid analysis, and brain imaging. With all tests negative, the child's condition was initially mistaken for botulism; however, an engorged tick was later found attached to the head skin. Following tick removal, the patient's weakness promptly improved with no additional interventions.
Our patient illustrates the importance of thorough skin examination in all cases of acute progressive weakness and the necessity to include tick paralysis in the differential diagnosis of paralysis, even in nonendemic areas.
蜱瘫痪是一种节肢动物传播的疾病，可导致潜在致命的进行性上行性肌无力。蜱瘫痪的临床表现与周围神经系统和脊髓的急性炎症性疾病重叠；因此，该病常被误诊，导致不必要的治疗和住院时间延长。
一名居住在纽约北部、无蜱虫流行地区旅行史的2岁女孩，出现快速进展的上行性瘫痪、反射减退，感觉检查正常。检查包括血液和血清毒理学筛查、脑脊液分析和脑部成像。所有检查结果均为阴性，该患儿的病情最初被误诊为肉毒中毒；然而，后来发现一只饱血的蜱虫附着在头皮上。去除蜱虫后，患者的肌无力症状迅速改善，无需额外干预。
我们的患者表明，在所有急性进行性肌无力病例中进行全面皮肤检查的重要性，以及在瘫痪的鉴别诊断中纳入蜱瘫痪的必要性，即使在非流行地区也是如此。
