Ruitenberg A, Vecht Ch J, van den Bent M J, Taal W
Erasmus MC, afd. Neurologie, Rotterdam.
Ned Tijdschr Geneeskd. 2005 Aug 6;149(32):1785-90.
A 78-year-old man with metastasised prostate carcinoma presented with a painless paraparesis. His cerebrospinal fluid showed elevated protein and a mononuclear pleiocytosis, but cytology investigations of 5 separate samples revealed no malignant cells in the cerebrospinal fluid. Extensive viral and bacterial tests (including ELISA for Borrelia burgdorferi) of serum and cerebrospinal fluid were negative. On the day radiation therapy for presumed leptomeningeal metastases was due to start the IgG and IgM Western blot for Borrelia were found to be positive, indicating neuroborreliosis. Soon after the start of antibiotic therapy the paraparesis began to improve and after four weeks the patient had made a complete recovery. In patients with a progressive paraparesis, neuroborreliosis should be considered even in the absence of pain.
一名78岁的前列腺癌转移患者出现无痛性双下肢轻瘫。他的脑脊液显示蛋白升高和单核细胞增多，但对5份独立样本进行的脑脊液细胞学检查未发现恶性细胞。对血清和脑脊液进行的广泛病毒和细菌检测（包括伯氏疏螺旋体酶联免疫吸附测定）均为阴性。在预定开始针对疑似柔脑膜转移的放射治疗当天，发现伯氏疏螺旋体的IgG和IgM免疫印迹呈阳性，提示神经型莱姆病。抗生素治疗开始后不久，双下肢轻瘫开始改善，四周后患者完全康复。对于进行性双下肢轻瘫患者，即使没有疼痛，也应考虑神经型莱姆病。
