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The precise pathophysiology underlying the tick's toxic effect in tick paralysis (TP) has not been clearly defined, because repetitive motor-nerve stimulation (RMNS) findings are normal in TP. Most hypotheses about the pathophysiology have focused on the nerve terminal per se or on the neuromuscular junction (NMJ). Clinical researchers now describe an interesting, well-defined clinical neurophysiologic assessment of TP that presented in a most unusual fashion: A limited form of TP confined to the brachial plexus. The offending, tiny tick (Ixodes holocyclus, native to Australia) was identified within the adjacent axilla.
Findings from classic distal motor-nerve conduction studies (MNCS) were normal. However, multilevel proximal MNCS demonstra…