Spirin N N, Baranova N S, Fadeeva O A, Shipova E G, Stepanov I O
Zh Nevrol Psikhiatr Im S S Korsakova. 2011;111(7):8-12.
The Yaroslavl region is an endemic area for Lyme disease (LD) with one of the highest levels of morbidity in Russia. Chronic neuroborreliosis can mimic multiple sclerosis and cause considerable difficulties in differential diagnosis. A comparative clinical-instrumental analysis of patients with definite multiple sclerosis (n=65) and chronic borrelial encephalomyelitis (n=11) was carried out. The key differential-diagnostic features of multiple sclerosis and borrelial encephalomyelitis were specified. Migrating erythema and tick's bite in the anamnesis, combined with lesions of the central and peripheral nervous systems, the absence of retrobulbar neuritis in the anamnesis, artralgia and myalgia, the high blood sedimentation rate were not characteristic of multiple sclerosis. A patient with abovementioned findings should be tested for the presence of antibodies to Borrelia burgdorferi in the blood serum and, if necessary, in the cerebrospinal fluid to exclude the diagnosis of Lime disease.
雅罗斯拉夫尔地区是莱姆病(LD)的地方性流行区,其发病率在俄罗斯处于最高水平之一。慢性神经型莱姆病可酷似多发性硬化症,并在鉴别诊断中造成相当大的困难。对确诊的多发性硬化症患者(n = 65)和慢性伯氏疏螺旋体脑脊髓炎患者(n = 11)进行了临床-仪器比较分析。明确了多发性硬化症和伯氏疏螺旋体脑脊髓炎的关键鉴别诊断特征。病史中有游走性红斑和蜱叮咬,伴有中枢和周围神经系统病变,病史中无球后视神经炎、关节痛和肌痛,血沉高,这些都不是多发性硬化症的特征。有上述表现的患者应检测血清中抗伯氏疏螺旋体抗体,必要时检测脑脊液中的抗体,以排除莱姆病的诊断。