A 12-year-old boy is brought to the emergency department due to unsteadiness, weakness, and falls. The patient recently went on a week-long family camping and hiking trip to the mountains in Washington State. On returning home to California 2 days ago, he experienced a sense of fatigue and a tingling sensation in his fingers. Yesterday, the patient started having bilateral leg weakness and is now unable to walk without assistance; he sways from side to side when standing and then falls to the floor. The patient has had no fever, headache, joint pain, or skin rash and has no history of recent respiratory or gastrointestinal illness. Vital signs are within normal limits. He is alert and active but can stand only briefly before requiring assistance. There is no increased resistance to neck flexion. Cranial nerve examination is normal and sensation is not impaired. Muscle strength is 4/5 in the upper extremities and 2/5 in the lower extremities. Deep tendon reflexes are absent at the knees and ankles but are normal elsewhere. Finger-to-nose testing shows dysmetria of the arms. Diagnostic intervention reveals significant findings. Which of the following is most likely to improve this patient's condition?

Question

A 12-year-old boy is brought to the emergency department due to unsteadiness, weakness, and falls.  The patient recently went on a week-long family camping and hiking trip to the mountains in Washington State.  On returning home to California 2 days ago, he experienced a sense of fatigue and a tingling sensation in his fingers.  Yesterday, the patient started having bilateral leg weakness and is now unable to walk without assistance; he sways from side to side when standing and then falls to the floor.  The patient has had no fever, headache, joint pain, or skin rash and has no history of recent respiratory or gastrointestinal illness.  Vital signs are within normal limits.  He is alert and active but can stand only briefly before requiring assistance.  There is no increased resistance to neck flexion.  Cranial nerve examination is normal and sensation is not impaired.  Muscle strength is 4/5 in the upper extremities and 2/5 in the lower extremities.  Deep tendon reflexes are absent at the knees and ankles but are normal elsewhere.  Finger-to-nose testing shows dysmetria of the arms. Diagnostic intervention reveals significant findings.  Which of the following is most likely to improve this patient's condition?

Quizplus · Accepted Answer

Explanation: Patients with tick paralysis require a meticulous skin examination to identify the causative tick. Tick removal eliminates the precipitating neurotoxin and usually results in significant clinical improvement within a few hours. Most patients recover completely without further intervention or medications. (Choice A) Equine serum heptavalent antitoxin is used to treat botulism. Botulism typically causes a descending paralysis starting in the cranial nerves. (Choice B) High-dose intravenous glucocorticoids are used to treat transverse myelitis. Transverse myelitis typically causes a sensory level and altered sensation in the lower extremities. (Choice D) Tick removal is usually curative and the treatment of choice. (Choice E) Therapeutic plasma exchange reduces time to recovery in patients with Guillain-Barré syndrome. This syndrome usually develops over several days or weeks (not hours) and is frequently preceded by a gastrointestinal or respiratory illness. Educational objective: Patients with tick paralysis require a meticulous skin examination to identify the causative tick. Tick removal usually significantly improves symptoms within several hours. Most patients recover completely without further intervention.

A 12-Year-Old Boy Is Brought to the Emergency Department Due