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[临床表现符合神经莱姆病患者的抗伯氏疏螺旋体抗体阳性]

[Positive anti-Borrelia antibodies in patients with clinical manifestations compatible with neuroborreliosis].

作者信息

Izquierdo G, Aguilar J, Barranquero A, Navarro G, Borobio M V, Angulo S, Domínguez I, Quesada M A

机构信息

Servicio de Neurología, Hospital Universitario Virgen de la Macarena, Sevilla.

出版信息

Neurologia. 1992 Feb;7(2):50-4.

PMID:1610600
Abstract

The clinical features of 19 patients with neurological manifestations unexplained by another disease and positive serology for Borrelia burgdorferi were studied. ECM was present in only 11% of the cases and 32% referred tick bite. The characteristic features for suspicion of NB according to our series was the presence of polyneuritis in 84% of the cases specially in the form of multiple mononeuritis and involvement of the facial nerve (79%) leading to even greater suspicion with the association of V pair involvement. Seizures, sleep disorders, and higher mental dysfunction may be found in association with other more characteristic neurological features. The typical triad of NB (aseptic meningitis, facial paralysis and polyradiculoneuritis) was found in 21% of the patients and in the absence of another disease to justify the same neuroborreliosis (NB) seemed evident. In all the cases components of this triad were found. Headache, arthralgia, fever and, less frequently, arthritis are other symptoms often past with the presence of anti-BB antibodies. Patients with the shortest evolution most frequently presented antecedents of facial paralysis, sensory alterations and Romberg's sign than patients of longer evolution. CSF demonstrated the presence of pleocytosis in 24% of the cases and in only one patient a slight increase in the intrathecal activity of IgG was observed which may be of use in differential diagnosis with MS. MR showed alterations in 61% of the patients and, while not specific, the lesions present subcortical predominance.

摘要

对19例有神经学表现且无法用其他疾病解释、伯氏疏螺旋体血清学呈阳性的患者的临床特征进行了研究。仅11%的病例出现游走性红斑,32%的患者提及有蜱叮咬史。根据我们的系列研究,疑似神经型莱姆病的特征性表现为84%的病例存在多发性神经炎,特别是以多发性单神经炎的形式出现,且面神经受累(79%),若伴有三叉神经受累则更可疑。癫痫发作、睡眠障碍及高级精神功能障碍可能与其他更具特征性的神经学表现相关。21%的患者出现了神经型莱姆病的典型三联征(无菌性脑膜炎、面瘫和多发性神经根炎),且在无其他疾病可解释相同情况时,神经型莱姆病似乎很明显。所有病例均发现了该三联征的组成部分。头痛、关节痛、发热以及较少见的关节炎是抗伯氏疏螺旋体抗体阳性时常见的其他症状。病程最短的患者比病程较长的患者更常出现面瘫、感觉改变和闭目难立征等前驱症状。24%的病例脑脊液显示有细胞数增多,仅1例患者观察到鞘内IgG活性略有升高,这可能有助于与多发性硬化进行鉴别诊断。61%的患者磁共振成像显示有改变,虽然不具有特异性,但病变以皮质下为主。

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