Halperin John J
Overlook Medical Center, Department of Neurosciences, 99 Beauvoir Ave, Summit, NJ 07902, USA.
Continuum (Minneap Minn). 2012 Dec;18(6 Infectious Disease):1338-50. doi: 10.1212/01.CON.0000423850.24900.3a.
This article will enable the reader to diagnose and treat nervous system Lyme disease appropriately.
Appropriately applied serologic testing has high positive and negative predictive values in nervous system Lyme disease. Oral antibiotics can be curative in most cases.
Infection with the tick-transmitted spirochete Borrelia burgdorferi causes Lyme disease, a disorder that involves the nervous system in about 15% of patients. Common manifestations include lymphocytic meningitis, cranial neuritis (particularly cranial nerve VII), painful radiculitis, other forms of mononeuropathy multiplex, and rarely CNS parenchymal involvement. Diagnosis is supported primarily by demonstration of anti-B. burgdorferi antibodies in serum. CSF examination can be informative in problematic cases with parenchymal CNS infection or to identify meningitis. However, oral antibiotics are probably effective in patients with meningitis and other forms of involvement, with the likely exception of parenchymal CNS infection.
本文将使读者能够正确诊断和治疗神经系统莱姆病。
适当应用血清学检测在神经系统莱姆病中具有较高的阳性和阴性预测价值。大多数情况下口服抗生素可治愈。
由蜱传播的螺旋体伯氏疏螺旋体感染引起莱姆病，约15%的患者会累及神经系统。常见表现包括淋巴细胞性脑膜炎、颅神经炎（尤其是面神经VII）、疼痛性神经根炎、其他形式的多发性单神经病，很少有中枢神经系统实质受累。诊断主要依靠血清中抗伯氏疏螺旋体抗体的检测。脑脊液检查对于中枢神经系统实质感染的疑难病例或诊断脑膜炎可能有帮助。然而，口服抗生素可能对患有脑膜炎和其他形式受累的患者有效，但中枢神经系统实质感染可能除外。
