Tick paralysis as a cause of autonomic dysfunction in a 57-year-old female

Both Guillain-Barré and tick paralysis can present with ataxia and acute, ascending, flaccid motor paralysis. While autonomic dysfunction has been identified in Guillain-Barré, it has never been reported in association with tick paralysis--possibly due to the rapid recovery of tick paralysis patients after removal of the tick. We present a case report of a patient with ascending weakness, ocular disturbances, ataxia, weakness, tachycardia and new hypertension who was initially thought to have Guillain-Barré syndrome with autonomic dysfunction. On hospital day two, a tick was removed, and the patient's symptoms of paralysis and autonomic dysfunction began to resolve. To our knowledge, this is the first reported case of autonomic dysfunction associated with tick paralysis.