Laufer Christin B, Chiota-McCollum Nicole
Department of Internal Medicine, Keesler Medical Center, Biloxi, MS, 39534, USA,
J Gen Intern Med. 2015 Aug;30(8):1225-7. doi: 10.1007/s11606-015-3276-8. Epub 2015 Mar 21.
Tick paralysis is caused by a neurotoxin secreted in the saliva of a gravid female tick, and manifests with ataxia, areflexia, ascending paralysis, bulbar palsy, and ophthalmoparesis. An 84-year-old man presented in June in coastal Mississippi with several days of subacute ataxia, bulbar palsy, unilateral weakness, and absent deep tendon reflexes. MRI/MRA and extensive serum and cerebrospinal fluid investigations were unrevealing. His symptoms progressed over several days, until his nurse discovered and removed an engorged tick from his gluteal fold. Within hours of tick removal, his subacute symptoms completely resolved. While tick paralysis is rare in adults, it is a condition that internists should be familiar with, particularly in seasons and areas with high prevalence of disease. This case also highlights the importance of performing a thorough skin exam on patients with the aforementioned neurologic abnormalities.
蜱瘫痪是由妊娠雌蜱唾液中分泌的一种神经毒素引起的，表现为共济失调、反射消失、上行性麻痹、延髓麻痹和眼肌麻痹。一名84岁男性于6月在密西西比州沿海地区就诊，出现了数天的亚急性共济失调、延髓麻痹、单侧无力和深部腱反射消失。MRI/MRA以及广泛的血清和脑脊液检查均未发现异常。他的症状在数天内逐渐加重，直到他的护士在他的臀褶处发现并取出了一只饱血的蜱。蜱被移除后的数小时内，他的亚急性症状完全消失。虽然蜱瘫痪在成年人中很少见，但这是内科医生应该熟悉的一种疾病，尤其是在疾病高发的季节和地区。该病例还强调了对有上述神经异常的患者进行全面皮肤检查的重要性。
