Acute transverse myelitis in Lyme neuroborreliosis
Acute transverse myelitis in Lyme neuroborreliosis
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DOI：
10.1007/s15010-010-0028-x
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发表时间：
2010-10-01
期刊：
影响因子：
7.5
通讯作者：
Steinlin, M.
中科院分区：
文献类型：
--
作者：
Bigi, S.;Aebi, C.;Steinlin, M.
急性横贯性脊髓炎(ATM)是一种罕见的疾病(每年每百万人口中有1-8例新病例)，所有病例中有20%发生在18岁以下的患者中。诊断需要临床症状和脊髓内炎症的证据(脑脊液和/或磁共振成像)。由神经疏螺旋体病引起的ATM通常具有令人印象深刻的临床表现。我们在此报告一例莱姆氏疏螺旋体病相关ATM病例，有严重的MRI和脑脊液表现，但出人意料的是临床表现很少，而且伯氏疏螺旋体免疫球蛋白G-CSF/血液指数转换较晚。即使影像研究显示，神经疏螺旋体相关性ATM的临床症状和体征可能很轻微，即使在严重累及脊柱的病例中也是如此。早期脑脊液/血液指标可为阴性，不排除莱姆氏脑疏螺旋体病；如果临床怀疑莱姆氏脑疏螺旋体病，应开始适当治疗，并重复脑脊液/血液指标以确认诊断。
Acute transverse myelitis (ATM) is a rare disorder (1-8 new cases per million of population per year), with 20% of all cases occurring in patients younger than 18 years of age. Diagnosis requires clinical symptoms and evidence of inflammation within the spinal cord (cerebrospinal fluid and/or magnetic resonance imaging). ATM due to neuroborreliosis typically presents with impressive clinical manifestations.Here we present a case of Lyme neuroborreliosis-associated ATM with severe MRI and CSF findings, but surprisingly few clinical manifestations and late conversion of the immunoglobulin G CSF/blood index of Borrelia burgdorferi sensu lato.Clinical symptoms and signs of neuroborrelial ATM may be minimal, even in cases with severe involvement of the spine, as shown by imaging studies. The CSF/blood index can be negative in the early stages and does not exclude Lyme neuroborreliosis; if there is strong clinical suspicion of Lyme neuroborreliosis, appropriate treatment should be started and the CSF/blood index repeated to confirm the diagnosis.