A Case of Subacute Ataxia in the Summertime: Tick Paralysis

J Gen Intern Med. 2015 Aug;30(8):1225-7. doi: 10.1007/s11606-015-3276-8. Epub 2015 Mar 21.


Tick paralysis is caused by a neurotoxin secreted in the saliva of a gravid female tick, and manifests with ataxia, areflexia, ascending paralysis, bulbar palsy, and ophthalmoparesis. An 84-year-old man presented in June in coastal Mississippi with several days of subacute ataxia, bulbar palsy, unilateral weakness, and absent deep tendon reflexes. MRI/MRA and extensive serum and cerebrospinal fluid investigations were unrevealing. His symptoms progressed over several days, until his nurse discovered and removed an engorged tick from his gluteal fold. Within hours of tick removal, his subacute symptoms completely resolved. While tick paralysis is rare in adults, it is a condition that internists should be familiar with, particularly in seasons and areas with high prevalence of disease. This case also highlights the importance of performing a thorough skin exam on patients with the aforementioned neurologic abnormalities.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Animals
  • Buttocks / pathology
  • Gait Ataxia / diagnosis*
  • Humans
  • Male
  • Muscle Weakness / diagnosis*
  • Physical Examination
  • Seasons*
  • Tick Paralysis / diagnosis*
  • Ticks*