Chronic Lyme neuroborreliosis

Abstract

Introduction. Lyme neuroborreliosis is an infectious disorder of the central and/or peripheral nervous system caused by the tick stump of the genus Ixodes rici, infected with species Borrelia burgdorferi sensu lato (in Europe). The disease manifests as meningitis, encephalitis, meningoradiculitis, vasculitis, paresthesia of the facial nerve and painful radiculopathy. Case report. A 44-year-old patient reports fatigue, forgetfulness, headache, confusion, depression, drowsiness, irritability, instability, her undercooks are crushed, sheeps of a bride and does not recall being called an object. Muscular reflexes of the undergrowth are reduced. Plantar response flexion, Lazarevic sign is positive at 45 degrees from the surface. No weakness of the dorsal and plantar flexion of the fingers of the feet. Relieves sensitivity in the region of inertia nerv peroneus and tibialis. Sphincters were fine. The patient had a diagnosed Lyme disease, five months prior to the exacerbation of anxiety. Due to erythema migrans and subfebrility, diagnosis and seropositivity to Borrelia burgdorferi were established in both classes of the enzymelinked immunosorbent assay antibodies and a confirmed Western blot test. She took doxycycline 200 milligrams/day, three weeks. The analysis of cerebrospinal fluid revealed proteinhorn (0.42 g/L), normal glycorrhachia, pleocytosis, and positive intrathecal IgG antibodies. Electromyography pointed to axonal degeneration of the lower extremities. The magnetic resonance is neat. The therapy includes ceftriaxone, 2 grams/day, vitamins and analgesic therapy. Neuroborreliois was maintained by the laboratory during one-year follow-up. Mental disorders, headaches, confusion and irritability, neurological signs have significantly regressed. Conclusion. The gold standard in diagnostics of neuroborelliosis is the determination of intrathecal antibodies. For the definitive diagnosis, clinical signs of disease, pleocytosis and positive antibodies are necessary. Intrathecal antibodies remain long positive and they are not recommended for monitoring for the effects of therapy.

Keywords

• lyme neuroborreliosis
• headache
• neuropathy
• paresthesia
• antibiotics