Pediatric EMG Cases-Dr. Abdel-Hamid Presentation

Dr. Abdel-Hamid Presentation

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The document presents a case study from UPMC Children’s Hospital of Pittsburgh, authored by Dr. Hoda Z. Abdel-Hamid, involving a 5-year-old Amish girl experiencing ascending muscle weakness. Initially, her symptoms suggested Guillain-Barre Syndrome (GBS) potentially associated with Lyme disease due to the presence of a characteristic rash, targetoid lesions, and spinal nerve root enhancement observed on MRI. Despite treatment with IVIG and ceftriaxone targeting Lyme, her condition deteriorated, ultimately requiring intubation.<br /><br />Further electromyography (EMG) testing revealed diffuse motor axonal neuropathy, suggestive not of GBS, but a presynaptic defect like neuromuscular junction (NMJ) blockade. This led to a re-evaluation and, upon closer examination, revealed tick paralysis, caused by a neurotoxin from an engorged female tick. Tick paralysis can mimic conditions such as GBS, botulism, or myasthenia gravis, characterized by fatigue, ataxia, and ascending weakness.<br /><br />Treatment involved the identification and careful removal of the tick, after which supportive care for respiratory muscle weakness was administered. Improvement generally follows as early as within 24 hours of tick removal. The document also urges proper feedback through the AANEM app to enhance meeting quality and to claim session credits by October 19, 2025.<br /><br />This case highlights the importance of differential diagnosis in neurological presentations, especially in regions or populations where tick exposure is possible. The quick recovery upon removal of the tick underscores the efficacy of identifying and addressing the root cause promptly in suspected tick paralysis cases.

Keywords

UPMC Children's Hospital

ascending muscle weakness

Guillain-Barre Syndrome

Lyme disease

tick paralysis

neuromuscular junction

nmj

electromyography

EMG

neurotoxin

differential diagnosis

neurological presentations

EMG

electromyography

nmj

neuromuscular junction