All Posts Tagged With: "aseptic meningitis"

Full article: https://www.thieme-connect.com/ejournals/abstract/neuropediatrics/doi/10.1055/s-2006-974121

Excerpt:

Neuroborreliosis often presents with cranial nerve palsy, aseptic meningitis or meningoencephalitis. Cerebral arteriopathy has rarely been reported as single cases. Here we present a retrospective analysis from 1997 to 2005 in the Berlin area. In this period neuroborreliosis was confirmed in 47 children through the finding of specific antibodies against Borrelia burgdorferi in CSF.

22 (47%) suffered from facial palsy as a presenting symptome, in one of them the palsy was bilateral. Four children (9%) had palsies of other cranial nerves, and four patients (9%) presented with paresis of an arm, hemiparesis, or spastic paraparesis. 16 children (34%) reported headache on admission, 15 (32%) presented with myalgia and/or arthralgia. Two patients (4%) had paraesthesia, another two (4%) were atactic. Ten (21%) had unspecific symptoms such as fever, fatigue, loss of appetite, or nausea. Other symptoms included general slowdown, sensoric or motoric aphasia, agitation, confusion, incomplete Horner’s syndrome, and mucosa haemorrhage, each in one patient.

In 19 patients (40%) cerebral imaging was performed. 13 (68%) were found to be normal, or rather revealed typical lesions in a patient with an underlying neurofribromatosis type 1. In one child with hemiparesis, and in one with multiple cranial nerve palsies, arterial subtraction angiography (DAS) confirmed multifocal vasculitis and dissection of the left Aa. vertebralis and basilaris, respectively. In one girl with hemiplegia, MRI revealed an infarction of the according internal capsule. Although angiography was not done this finding is suspicious of focal arteriopathy. The girl also had a homozygous mutation of factor V Leiden.

Excerpt:

If you have multiple sclerosis (MS)––or you know someone who does––you probably remember how long it took to make the diagnosis.  You also may remember a lot of blood tests, a lumbar puncture, at least one magnetic resonance imaging (MRI) scan, as well as many visits and examinations by various doctors.  You may wonder why it still takes so long to make the diagnosis in this modern age of MRIs and other sophisticated tests.  We are going to try to explain why it can be so difficult for even the most expert MS neurologist to determine that someone has MS.  You have to live with the diagnosis and face the disease and the treatments.  You should understand and have confidence in the diagnosis.  Also, if your case of MS does not fit the typical pattern, you need to be aware of the other disorders that can mimic MS.  This is important because the treatments may be very different and, just as in most cases of MS, treatment begun early in the course of the disease is the best way to prevent or slow further neurologic damage.

MRI and new laboratory tests have definitely helped speed the diagnosis, but it still takes longer than anyone would wish, even in easy cases.  This is partly because of the variable nature of the disease in its many signs and symptoms. But it is also because a rather long list of other medical disorders can cause neurologic symptoms and signs that resemble MS. Furthermore, the “white spots” on brain MRI can be caused by a number of other conditions that also need to be ruled out.

The diagnosis of clinically definite MS requires that a person experience at least two neurologic symptoms of the type seen in MS, in two different areas of the central nervous system (CNS), at two different times (‘disseminated in space and time’).  Most typically, the symptoms are optic neuritis plus either an abnormal sensation or a problem with movement.  It can also be numbness in one part of the body and weakness or lack of coordination in another.  But in every case, there can be no other explanation for the symptoms, the changes seen on the MRI, and the abnormalities in the spinal fluid.  Many “mimics” need to be ruled out in order to make the diagnosis of MS.