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Five Year Old who Can't Walk A five year old girl was seen at an emergency room because of inability to walk. It started that same morning upon waking up. The family just came from a four day camping trip. She has been very healthy and never been ill before. Her immunization is complete. She has no fever, headache, vomiting, diarrhea, rashes, joint pains, belly or back pains. There is no knows exposure to any toxic chemical or drugs. On physical examination, she is alert and cooperative. However, she could not walk nor stand. There was no pains at the legs. She has no deep tendon reflexes in her lower leg. Her vision and cranial nerves all normal as well as the rest of the physical examination. List the prominent features of this patient: Inability to stand and walk. There is no fever, vomiting, headache, and other symptoms.They just came from a camping trip. Start with a differential diagnosis or a list of possible causes of inability to walk or stand. Here is the list:
Close examination of her scalp showed an engorged tick at the occipital area. Within hours of the removal of the tick, the strength of her lower extremities improved. After 24 hours, she has recovered fully. Because of the history of recent camping trip, the ER physician examined the head closely and found the tick. This is a case solved because of attention to the detail of the history and meticulous examination of the scalp by the ER physician. Tick paralysis is a neurologic disorder characterized by an ascending paralysis in association with the attachment of certain tick. In North America, Dermacenter andersoni (Wood tick) and Dermacenter variabilis (dog tick), are the main arachnids involved in this disorder. Female ticks are the culprit in most instances because they firmly attached for a longer time than male tick. Tick paralysis is a summer and spring problem. Any progressive weakness or paralysis of the extremities, Guillain-Barre syndrome should be considered also because there a Treatment called Gamma-Globulin. It is given intravenously. Leo Leonidas, MD, FAAP
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