Department of Medicine, Division of Neurology, Queen’s University, Kingston, ON, Canada.
CJEM. 2012 Sep;14(5):321-4. doi: 10.2310/8000.2011.110512.
Lyme disease caused by the spirochete Borrelia burgdorferi is a multisystem disorder characterized by three clinical stages: dermatologic, neurologic, and rheumatologic. The number of known Lyme disease-endemic areas in Canada is increasing as the range of the vector Ixodes scapularis expands into the eastern and central provinces. Southern Ontario, Nova Scotia, southern Manitoba, New Brunswick, and southern Quebec are now considered Lyme disease-endemic regions in Canada. The use of field surveillance to map risk and endemic regions suggests that these geographic areas are growing, in part due to the effects of climate warming. Peripheral facial nerve palsy is the most common neurologic abnormality in the second stage of Lyme borreliosis, with up to 25% of Bell palsy (idiopathic peripheral facial nerve palsy) occurring due to Lyme disease. Here we present a case of occult bilateral facial nerve palsy due to Lyme disease initially diagnosed as Bell palsy. In Lyme disease-endemic regions of Canada, patients presenting with unilateral or bilateral peripheral facial nerve palsy should be evaluated for Lyme disease with serologic testing to avoid misdiagnosis. Serologic testing should not delay initiation of appropriate treatment for presumed Bell palsy.
由螺旋体伯氏疏螺旋体引起的莱姆病是一种多系统疾病，其特征为三个临床阶段：皮肤、神经和风湿。由于传播媒介硬蜱的范围扩大到加拿大东部和中部省份，加拿大已知的莱姆病流行地区的数量正在增加。安大略省南部、新斯科舍省、曼尼托巴省南部、新不伦瑞克省和魁北克省南部现在被认为是加拿大的莱姆病流行地区。利用现场监测来绘制风险和流行地区的地图表明，这些地理区域正在扩大，部分原因是气候变暖的影响。在莱姆螺旋体病的第二阶段，周围性面神经麻痹是最常见的神经异常，高达 25%的贝尔麻痹（特发性周围性面神经麻痹）是由莱姆病引起的。在这里，我们介绍了一例最初诊断为贝尔麻痹的隐匿性双侧面神经麻痹的莱姆病病例。在加拿大的莱姆病流行地区，出现单侧或双侧周围性面神经麻痹的患者应进行莱姆病血清学检测以排除误诊。血清学检测不应延迟对疑似贝尔麻痹的适当治疗的开始。
