An attached tick is usually present. Onset of symptoms is usually 4-7 days after attachment.
Most cases occur in the spring or early summer.
Clinical findings:
(1) Initially the patient experiences paresthesias and motor problems in the extremities, usually starting in the lower limbs. Many patients present with an ataxic gait.
(2) This is followed by an ascending, symmetric, and flaccid paralysis that develops over the next 1-2 days to involve the upper limbs, face and cranial nerves.
(3) The patient may develop ophthalmoplegia, bulbar paralysis (difficulty speaking, difficult swallowing) and/or cerebellar dysfunction.
(4) Severe cases will progress to respiratory paralysis.
(5) Death can occur, especially if the tick is not removed (see previous section).
Neurologic exam (Felz et al):
(1) Muscle-tendon stretch reflexes are absent.
(2) Babinski's sign is absent.
(3) There is no sensory loss.
(4) There are no meningeal signs.
(5) CSF protein and white blood cell count are normal.
Other findings:
(1) Mild irritation and pruritis may occur at the site of the tick attachment.
(2) Pediatric patients may become irritable prior to the onset of the paralysis.
(3) Fever is absent and other findings tend to be infrequent and mild.
