Extracranial Etiology of Acute Onset Ataxia and Weakness: Small but Deadly.

Abstract

A 4-year-old girl presented to the emergency department as a stroke alert with acute onset ataxia and leg weakness. She experienced repeated falls and inability to move her legs. Her neurologic examination revealed ataxia, bilateral distal predominant weakness, and loss of reflexes. She underwent brain MRI which identified a tick on the right occiput (Figure 1). The patient decompensated and was sent to the pediatric intensive care unit where the tick was carefully removed (Figure 2). She fully recovered 4 days later.