SHM Converge Scientific Abstract ePoster Gallery-Pediatric Weakness: No Need to Tick All the Boxes

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This case report highlights tick paralysis as an important, often underrecognized cause of acute ascending weakness in children. A 3-year-old girl returned from a bear-hunting trip in Idaho and developed 4 days of progressive difficulty walking, urinary retention, and worsening upper extremity weakness with hyporeflexia. Her mother eventually found and removed an engorged tick from the child’s occipital scalp before she presented for care.<br /><br />On exam, the child had weakness in all extremities, greatest in the legs, inability to walk, diminished reflexes, and difficulty urinating. Despite the classic presentation and tick removal, she underwent a head CT, laboratory testing, and hospital admission. The CT was negative, and labs were unremarkable. By the next morning, her strength had significantly improved, and she was discharged.<br /><br />The authors explain that tick paralysis is caused by a neurotoxin in tick saliva, most commonly from Dermacentor species, and typically appears after 3–7 days of attachment. It is especially common in preschool-aged children, particularly those with long hair, which can conceal the tick and delay diagnosis. Symptoms usually improve within hours after proper tick removal.<br /><br />The differential diagnosis for acute pediatric weakness is broad and includes Guillain-Barré syndrome, acute cerebellar ataxia, botulism, and poliomyelitis. However, this case demonstrates that careful history and physical examination can identify tick paralysis and prevent unnecessary testing, hospitalization, cost, and potential harm from incidental findings. The key message is that clinicians should consider tick paralysis early in children with acute neurologic weakness, especially after travel to endemic regions.

Asset Subtitle

Valentina Bonnefil

Meta Tag

Author List Nathan Money, Valentina Bonnefil

Category Clinical Vignettes

Concept Tick Paralysis

Concept Ascending Weakness

Concept Tick Removal

Concept Hyporeflexia

Concept History Taking

Distinguished Non-Finalist

Presenter Organization Rocky Vista College of Osteopathic Medicine

Presenting Author Valentina Bonnefil

Track Pediatric

Keywords

tick paralysis

acute ascending weakness

children

hyporeflexia

urinary retention

Dermacentor

neurotoxin

tick removal

pediatric neurology

differential diagnosis

Tick Paralysis

Ascending Weakness

Tick Removal

Hyporeflexia

History Taking