All Posts Tagged With: "neuroborreliosis"

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:

The laboratory diagnosis of early disseminated Lyme borreliosis
(LB) rests on IgM and IgG antibodies in serum. The purpose of
this study was to refine the statistical interpretation of IgM
and IgG by combining the diagnostic evidence provided by the two
immunoglobulins and exploiting the whole range of the
quantitative variation in test values. ELISA assays based on
purified flagella antigen were performed on sera from 815 healthy
Danish blood donors as negative controls and 117 consecutive
patients with confirmed neuroborreliosis (NB).

Full article: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20402677&retmode=ref&cmd=prlinks

Full article: http://informahealthcare.com/doi/abs/10 … 1003687294

Excerpt:

A 57-year-old man was referred for a painful acute inferior visual field defect in his right eye.
Fundus examination of the right eye revealed diffuse optic disc oedema compatible with a papillitis. Cerebrospinal fluid (CSF) findings were consistent with lymphocytic meningitis, and serologic tests for Lyme disease were positive in both serum and CSF.
After treatment with ceftriaxone and bolus of methylprednisolone, right eye inferior altitudinal visual field defect persisted despite resolution of papillitis, and fundus examination disclosed a superior optic atrophy in the right eye.
To our knowledge, it is the first reported case of a unilateral Lyme optic neuritis occurring simultaneously to neuroborreliosis and further complicated by non-arteritic anterior ischaemic optic neuropathy

Excerpt:

The central nervous system is involved in 10-20% of cases in Lyme
disease. The neurological symptoms, time course of the disease and
imaging findings are multifaceted. We report two patients with cervical
radiculitis. Magnetic resonance imaging revealed strong enhancement of
the cervical nerve roots on contrast-enhanced T1-weighted images. These
imaging patterns of borrelia-associated radiculitis have not been
reported before. Knowledge of these imaging features may help to
diagnose neuroborreliosis, which presents with non-specific symptoms.

Excerpt:

OBJECTIVE: We report an extremely rare case of recurrent laryngeal nerve paralysis due to subclinical Lyme borreliosis. METHOD: Case report presenting a 15-year-old girl referred with hoarseness and soft voice. RESULTS: Right-sided recurrent laryngeal nerve paralysis was observed using videolaryngoscopy. Imaging was used to exclude intracranial, cervical and intrathoracic embryological lesions, vascular malformations and tumours. Laboratory and electrophysiological investigations were used to exclude inflammatory and paraneoplastic processes, endocrinopathy and metabolic disorders. Serological testing was positive for Lyme disease. Parenteral ceftriaxone therapy was commenced. The patient’s nerve paralysis showed complete recovery on the seventh day of antibiotic treatment; this was confirmed by videolaryngoscopy. CONCLUSION: Recurrent laryngeal nerve paralysis is an extremely rare complication of neuroborreliosis associated with Lyme disease. In patients with recurrent laryngeal nerve paralysis in whom the clinical history is uncertain and the usual diagnostic methods give negative results, screening with anti-borrelia immunoglobulin M is suggested.

Background.Standard 2‐tiered immunoglobulin G (IgG) testing has performed well in late Lyme disease (LD), but IgM testing early in the illness has been problematic. IgG VlsE antibody testing, by itself, improves early sensitivity, but may lower specificity. We studied whether elements of the 2 approaches could be combined to produce a second‐tier IgG blot that performs well throughout the infection. Continued

Only two spirochetal infections are known to cause nervous system infection and
damage: neurosyphilis and neuroborreliosis (nervous system Lyme disease).
Diagnosis of both generally relies on indirect tools, primarily assessment of
the host immune response to the organism. Reliance on these indirect measures
poses some challenges, particularly as they are imperfect measures of treatment
response. Despite this, both infections are known to be readily curable with
straightforward antimicrobial regimens. The challenge is that, untreated, both
infections can cause progressive nervous system damage. Although this can be
microbiologically cured, the threat of permanent resultant neurologic damage,
often severe in neurosyphilis and usually less so in neuroborreliosis, leads to
considerable concern and emphasizes the need for prevention or early and
accurate diagnosis and treatment.

Clinical practice guidelines are increasing in number. Unfortunately,
when scientific evidence is uncertain, limited, or evolving, as is often
the case, conflict often arises between guideline committees and
practicing physicians, who bear the direct responsibility for the care of
individual patients. The 2006 Infectious Diseases Society of America
guidelines for Lyme disease, which have limited scientific support,
could, if implemented, limit the clinical discretion of treating physicians
and the treatment options available to patients

Introduction

Clinical practice guidelines are now ubiquitous throughout the
United States. The National Guidelines Clearing House, under the
category “diseases,” currently lists 2,126 separate guidelines on its
web site. Clinical guidelines are intended to assist physicians in
patient care by clearly communicating the results of the guideline
committees’ evaluation of available therapeutic options. However,
the processes by which individual guidelines are constructed may be
less clear, leading to disagreements between the issuing committee
and the physicians who treat patients-physicians who may well be
as experienced and knowledgeable as the guideline committee. Continued