SHM Converge Scientific Abstract ePoster Gallery-Wobble Baby, Wobble Baby: A Case to Comb Through

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This case describes a 4-year-old previously healthy girl who developed acute gait unsteadiness and weakness, initially concerning for serious neurologic disease. She had a recent mild viral illness but no toxic exposures, altered mental status, sensory symptoms, swallowing problems, or respiratory distress. On exam, she had normal mental status and cranial nerves, but showed truncal and neck flexion weakness, inability to sit or stand unassisted, narrow-based clumsy steps, and notably absent deep tendon reflexes. These findings raised concern for conditions such as encephalitis, Guillain-Barré syndrome, botulism, or tick paralysis rather than simple acute cerebellar ataxia.<br /><br />Because of the concerning exam, she underwent MRI brain and lumbar puncture, both of which were normal. During sedation for the procedure, a more complete skin exam revealed an American dog tick, which was removed entirely. After tick removal, her neurologic status improved rapidly: by the next day she could walk without support and reflexes began to return.<br /><br />The case highlights that tick paralysis can mimic acute cerebellar ataxia or Guillain-Barré syndrome in children, but areflexia and rapid progression are important warning signs. Although uncommon, tick paralysis should be considered in any child with sudden-onset ataxia or weakness, and a careful full-body skin exam is essential even if it requires sedation. Prompt tick removal typically leads to full recovery, but delayed recognition can result in respiratory failure and death.

Asset Subtitle

Stacey Chung

Meta Tag

Author List Jonathon Heath, Melissa R. Wooten, Nathaniel Wooten, Stacey Chung

Category Clinical Vignettes

Concept Tick Paralysis

Concept Gait Instability

Concept Acute Cerebellar Ataxia

Concept Areflexia

Concept Attached Tick

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author Stacey Chung

Track Pediatric

Keywords

tick paralysis

acute gait unsteadiness

areflexia

American dog tick

pediatric weakness

acute cerebellar ataxia

Guillain-Barré syndrome

neurologic exam

tick removal

rapid recovery

Tick Paralysis

Gait Instability

Acute Cerebellar Ataxia

Areflexia

Attached Tick