Keith Van Haren, MD, a pediatric neurologist at the Lucile Packard Children’s Hospital at Stanford University, is accustomed to seeing children who present with rare cases of sudden-onset paralysis. These rare but serious emergencies can have a range of causes, including Guillain-Barré syndrome, botulism, or tick paralysis.

In 2012, Van Haren and his colleagues across the state noticed an unusual trend of cases of sudden-onset acute flaccid paralysis with motor neuron injury. Normally, he and his colleagues can expect to see 1 such case a year, he said. But in the autumn of 2012, 2 cases of this rare combination were seen, and a few more cases quickly followed.

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