Tick paralysis

Tick paralysis requires that the tick be attached for 4 to 5 days and is therefore rareHall-Mendelin, 2011The Department of Health, Last updated 25 November 2015; it takes a few days to manifest, presenting as an ascending paralysis, initially with leg weakness and an unsteady gait. In more severe envenoming, the weakness increases to involve the upper limbs, trunk and neck muscles. Facial and bulbar muscles can also be affected, causing ptosis, extraocular muscular paralysis, dysarthria and stridor, and ultimately respiratory muscle paralysis. Tick paralysis is an important differential diagnosis of ataxia in children. It can present, in less severe cases, as a regional or cranial nerve palsy in adults, and may mimic facial nerve (Bell) palsy. Mild to moderate tick paralysis usually requires no intervention except observation and serial neurological examinations for 48 hours after tick removal (the paralysis may progress after the tick is removed). In severe poisoning, treatment consists of advanced life support with intubation and mechanical ventilation for respiratory failure. Antivenom for tick paralysis is no longer available.