Contagious Paralysis or a Hidden Tick_ _ Chicago Med _ MD TV

Please, I need someone to see my daughter. She can barely walk in a straight line. Her foot keeps dragging. She's bumping into things. Ma'am, please take a seat. As soon as I have a doctor, I'll be with you. Denise, come over here, honey. Do you see what I mean? Oh my god. We need some help over here. We got her. Mom. Hi there. I can't feel my leg. OK. I'm Dr. Halstead. We're going to figure out why that is, all right? Thank you so much. She started complaining on the plane ride home from Australia. She said that her feet were tingling, that her legs hurt. I thought it was just from sitting so long. Did Denise do any outdoor activities while you were there, hiking, swimming? No. No hiking. We picnicked a couple of days. Deep tendon reflexes are absent. OK. I'm going to ask you to close your eyes. Super tight for me, all right? No peeking. And when I tap you on the leg, will you point to which side I'm tapping on? Yeah. Normal sensation to light touch. All right, can you lift your legs for me now? That's all I can do. Let's get a CBC, CMP, ESR, UTOX, and a brain and spinal CT and MRI, and do a full body scan for rashes and insect bites, OK? OK. Is she paralyzed? Let's not get ahead of ourselves, OK? While she is showing signs of paralysis, it's most likely temporary. It's probably a nerve compression injury from the lung flame. We're going to run these tests, and we'll take it from there. We'll be back soon. All done. You were so brave. Hey, Mom, we should have the results back within an hour or two. I don't understand. You said her tests were normal. They were. But she's getting worse. She can't move her legs at all anymore. We'll have a much clearer picture once we receive the results back on Denise's cerebral spinals. And we'll ask the lab to put a rash on these, OK? Thank you. Yeah. When you saw that girl's CSF, it was crystal clear. The lab's not going to tell us anything we don't already know. It's obviously not encephalitis, meningitis, Guillain-Barre syndrome. Hold on. Let's not rule out GBS. It fits her clinical presentation almost to a T. Normal blood work, ascending symmetrical paralysis, absent reflexes. Let's just do one more round of labs first. We're going to test for heavy metal poisoning, exotic infection. And if we don't get anything from those, I'm all for treating it as GBS, OK? My daughter, she can't breathe. OK. Hey, Denise, look at me. Deep breaths for me, OK? In and out. Can you squeeze my hand? Can you lift your arms for me? What's happening? The paralysis is moving up her spine. And if it's time of day 50, it sucks we're intubating? You're going to put that down her throat? OK, why don't we give the doctor some room to work? No, please, please. I want to stay with my daughter. It's OK. We'll stay right here. OK. Couldn't do much of a neuro exam with her sedated and intubated, but if I had to guess, I'd say she's paralyzed. Thanks, Sam. Doing the hokey pokey there, Halstead? Huh? Your foot. Oh. Yeah, it just fell asleep. Kind of banged at the side. Never mind. You're right. We should have started IVIG and plasma exchange way earlier. It was a mistake to wait. No, you call it. I don't think it is a GBS anymore. It's progressing too rapidly. Nothing else it could be. I mean, GBS is the only thing on our differential that makes a modicum of sense. When did ED doctors get so polite with each other? You two dating or something? Never mind. Start with IVIG and plasmapheresis. At this point, I'm ready to throw the kitchen sink at this thing. Page me when her station wears off. You OK? Yeah. Any improvement? Denise's huge functional grade is still at five. Is she triggering the vent? No. IVIG isn't working. It's way too soon to know that. Give it some time. I think we need to try immunosuppressant. Are you OK? What happened? I don't know. My foot went numb. It just gave out. I can't feel anything, Sam. Press down on the gas pedal hard as you can. Have you been ill at all recently? Is it possible you're immunocompromised? How about any interactions with the patient? Any needle sticks? Is there a chance you exchanged fluids somehow? Only direct contact I had with the patient was when she collapsed. I carried her into the ED. How about you? Are you experiencing any numbness or tingling in your lower extremities? We haven't even established what Denise has yet, let alone if it's contagious. You think it's a coincidence, your paralysis? Where are you with your differential? We were operating under the hypothesis that she had Guillain-Barre syndrome. Well, that's obviously a dead end. GBS isn't contagious. I'm going to get started on an LP. Collect everything you've got thus far on the girl. Every test you gave her, you give him. See if we can find any patterns. Now, Dr. Manning. These just came in from radiology. Finally, thank you. I'm not seeing anything. Why was Will getting a brain MRI? What's going on, Natalie? Is he OK? Dr. Manning? Yeah. The PICU called. It's your patient, Denise. They need you upstairs. All of a sudden, I saw her leg move, and then she reached out for me. Reflexes are all back to normal. Denise, I'm going to have you stand for me now, OK? That's great. All right, now I'm going to have you walk to me, and I'm going to let go, all right? OK. Let's go. Sam, what am I missing? Best guess, some kind of toxin needed to work its way out of her system. But how that got to Will, I have no idea. Contagion's one thing, but this is more like a game of tag. Thank you, Dr. Manning. Tag, now you're it. Nat, what are you doing? You shouldn't be. Just look at your MRI. You see that bump above your coronal suture? Yeah. First, I thought it was a mole, but. What is it? Ah, there it is. There what is? Nat. Gotcha. Ow. Was that a tick? Uh-huh. Wait, is this Lyme disease? Nope, tick paralysis. The salivary gland produces a nerve toxin. This guy came all the way from Australia, courtesy of Denise. It must have detached from her scalp, but stayed in her hair. And when you picked her up, it attached to you. But if it was off her by the time we got Denise into the ED, how come the paralysis kept moving up her body? It typically worsens for a few hours once the tick is removed. So I'm not out of the woods yet. Nope. But the paralysis is mass dependent, so it shouldn't move as quickly up your body. But you still have to spend the night in the ICU. I got to get this to serology. Don't move. Ha ha.