1/5. tick paralysis: electrophysiologic studies.A patient with tick paralysis had motor and sensory nerve conduction studies before and after removal of an engorged tick. The amplitudes of muscle action potentials evoked by stimulation of motor nerves were reduced initially, returning to normal after the tick was removed. Distal motor and sensory latencies also shortened after removal, and conduction velocities were improved 6 months later. Direct stimulation of muscle produced a normal response, and tests of neuromuscular transmission were normal, including the response to edrophonium. These findings are compatible with experimental results showing effects of the toxin on motor nerve terminals as well as on large sensory and motor nerves.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/5. tick paralysis: atypical presentation, unusual location.We present 2 unrelated cases of tick paralysis presenting within a 2-month period in the greater philadelphia region, a geographic area in which this disease is highly unusual. Our first patient demonstrated early onset of prominent bulbar palsies, an atypical presentation. Our second patient, residing in a nearby but distinct community, presented with ascending paralysis 2 months after the first. The atypical presentation of our first patient and the further occurrence within a few months of a second patient, both from the Northeastern united states where this diagnosis is rarely made, suggest the need to maintain a high index of suspicion for this disease in patients presenting with acute onset of cranial nerve dysfunction or muscle weakness. Through simple diagnostic and therapeutic measures (ie, careful physical examination to locate and remove the offending tick), misdiagnosis and unnecessary morbidity can be avoided.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
3/5. tick paralysis with atypical presentation: isolated, reversible involvement of the upper trunk of brachial plexus.tick paralysis is a disease that occurs worldwide. It is a relatively rare but potentially fatal condition. The only way to establish the diagnosis is to carefully search for the tick paralysis. It is caused by a neurotoxin secreted by engorged female ticks. tick paralysis generally begins in the lower extremities and ascends symmetrically to involve the trunk, upper extremities and head within a few hours. Although early-onset prominent bulbar palsy and isolated facial weakness without generalised paralysis are rare, there is no report in the English literature concerning isolated, reversible involvement of the upper trunk of brachial plexus caused by tick bite. We report a case of isolated, reversible involvement of the upper trunk of brachial plexus as a variant of tick paralysis. diagnosis was confirmed with needle electromyography and nerve conduction examination. Within 2 weeks, the patient was fully recovered. The purpose of presenting this case is to remind clinicians that tick paralysis should be considered even in cases with atypical neurological findings admitted to the emergency department.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
4/5. tick paralysis: electrophysiologic measurements.Electrophysiologic measurements in a 9-year-old girl with tick paralysis demonstrated a prolonged distal latency and a decremental response to 30 Hz stimulation. The nerve conduction determinations became normal after clinical recovery. The pathophysiologic process of this disease seems to be within the peripheral nerve although a central site of action of tick toxin cannot be completely excluded. tick paralysis should be considered in the individual who develops ascending paralysis.- - - - - - - - - - ranking = 0.5keywords = nerve (Clic here for more details about this article) |
5/5. Clinical and neurophysiological features of tick paralysis.The clinical and neurophysiological findings in six Australian children with generalized tick paralysis are described. Paralysis is usually caused by the mature female of the species ixodes holocyclus. It most frequently occurs in the spring and summer months but can be seen at any time of year. Children aged 1-5 years are most commonly affected. The tick is usually found in the scalp, often behind the ear. The typical presentation is a prodrome followed by the development of an unsteady gait, and then ascending, symmetrical, flaccid paralysis. Early cranial nerve involvement is a feature, particularly the presence of both internal and external ophthalmoplegia. In contrast to the experience with North American ticks, worsening of paralysis in the 24-48 h following tick removal is common and the child must be carefully observed over this period. death from respiratory failure was relatively common in the first half of the century and tick paralysis remains a potentially fatal condition. Respiratory support may be required for > 1 week but full recovery occurs. This is slow with several weeks passing before the child can walk unaided. Anti-toxin has a role in the treatment of seriously ill children but there is a high incidence of acute allergy and serum sickness. Neurophysiological studies reveal low-amplitude compound muscle action potentials with normal motor conduction velocities, normal sensory studies and normal response to repetitive stimulation. The biochemical structure of the toxin of I. holocyclus has not been fully characterized but there are many clinical, neurophysiological and experimental similarities to botulinum toxin.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |