Medical Mystery: A Mother's Touch Solves It

July 27, 2006 — -- Keeley, a 5-year-old girl in suburban New Jersey, awoke in the middle of the night with alarming symptoms.

Keeley's mom, Tara, who asked that the family's last name not be used, says she heard a noise coming from her daughter's room at around 4:30 in the morning.

"I called my mom 'cause I was trying to stand-up but I couldn't. I just collapsed on the floor," Keeley said.

"I could tell right away there was something wrong with her speech. She said, 'Daddy, I'm seeing two of you," said Keeley's dad, Bill.

Tara said she couldn't understand how her daughter could be fine the day before and then so sick within 12 hours.

Tara and Bill rushed Keeley to the hospital, where their daughter got immediate attention in the intensive care unit.

Dr. Fred Henretig, professor of pediatrics and emergency medicine at the University of Pennsylvania School of Medicine and the head of the Clinical Toxicology section at Children's Hospital of Philadelphia, handled Keeley's care when she arrived at the hospital.

Henretig says a number of things were going through his mind. "What is going on here? Why is this child half-paralyzed? Trauma, poisonings, fulminate infections. Also, although more ominous -- you worry about brain tumors and some kind of vascular catastrophe such as a stroke."

Tara says the physician wanted to get an MRI of her daughter to see if they could see anything like a tumor.

"I was scared out of my mind. We found a seat in the waiting room and basically just prayed," said Bill.

Brain Tumor?

"We were in the waiting room for a while and then the doctor came out and said, 'Everything looked fine. There was no sign of a tumor, there was no sign of aneurysm,'" Tara said.

So the doctors started from scratch. "[We thought] about every other possibility of rapidly progressive weakness in a young child Keeley's age," said Henretig.

Tara says she remembers the doctors asking a lot of questions about what Keeley had been exposed to.

According to Henretig there are a number of poisonings that can cause weakness. "The most classic is botulism. In years gone by, polio could present this way. Of course, polio is very rare in the United States. And then tick paralysis, an illness brought on by the bite of certain species of ticks."

"I think they went on history for a lot of things as far as eliminating the botulism and the polio and the ticks and things like that," said Tara.

So then, Henretig says, "we shifted our thinking a little bit to consider Guillain-Barre syndrome, which is a poorly understood illness where your body, in essence, creates an immune reaction against the nerve roots in the spinal cord."

Doctors began considering Guillain-Barre because Keeley exhibited some of the symptoms, like weakness in the legs.

"They were leaning towards Guillain-Barre, and it was a disease that I had never heard of. And to start this process they would need to do a spinal tap," Bill said.

"The spinal tap itself was probably the worst part of the whole thing. Keeley was crying during that," Tara added.

Henretig says the doctors on the case were concerned that her weakness would progress rapidly. Typically, with Guillain-Barre, the weakness progresses upward through the body, eventually affecting the arms and then the respiratory muscles. That's when the syndrome becomes a life-threatening illness.

Spinal Tap

The doctors did a spinal tap on Keeley. The little girl remembers just how much that hurt: "I was in pain."

Henretig says she was in so much pain, her mother was comforting her. "After the procedure ... her mom was stroking her hair."

Ironically, the mother's comforting touch is what solved the medical mystery.

"My mom felt something right here, next to my ear. And then my dad looked at it and he said it was a tick," Keeley said.

Bill recalls just jumping up and down. "I ran into the hallway and yelled it out, 'It's a tick, it's a tick!'"

The tick was removed and Keeley's condition started to improve within a few hours.

"In a sense, it's as if the tick is actually giving you a little I-V infusion of its toxin," Henretig said. "Once the continuing injection of the toxin by the tick is ended, the patient begins to recover relatively quickly."

Keeley went from what doctors thought could be a potentially life-threatening illness to a cure just by removing a tick with a pair of tweezers. Henretig says Keeley's case was "a wonderfully gratifying experience... [it] taught us all a lesson we'll carry with us for the rest of our careers."