A Case of Ascending Paralysis: the Signs and Symptoms of Tick Paralysis

Menyoli Malafa, MSII; Veronica Tucci, JD, MS IV; Albert Vincent, PhD; Sajeel Chowdhary, MD


American Academy of Emergency Medicine. 2009;16(1):22, 26, 27 

In This Article

Summary and Case


Tick paralysis (TP), a response to the neurotoxic effects of the salivary secretions produced by attached hard ticks (Ixodidae), is a syndrome that mimics a large number of better known neurological disorders. TP is a sporadic, seasonal, rural disorder in which acute ataxia often develops five to six days following a history of walking in grass or low brush, followed by ascending flaccid paralysis. Recognition and timely removal of the tick usually leads to complete resolution of symptoms, whereas continued feeding can lead to respiratory arrest and death. Follow-up includes species determination and patient surveillance for tick-borne infectious disease.


A 42 year-old man was hiking in Colorado for one week in July. Upon returning to his home in Tampa, Florida, he felt flu-like symptoms and fatigue but no fever or rash was noted. Two days later, he developed global muscle weakness and presented to the emergency room. Upon physical exam, a tick was found under the hair of the right occipital area.

Question: The patient likely has which of the following diagnoses:

   a) Lyme Disease
   b) Guillain-Barre Syndrome (GBS)
   c) Colorado Tick Fever
   d) Tick Paralysis
   e) Babesiosis