Nangaku M, Tamaoka A, Iguchi K, Inoue K, Mannen T
Department of Neurology, Tokyo University School of Medicine.
Rinsho Shinkeigaku. 1990 Jan;30(1):84-7.
A 39-year-old man experienced an abrupt onset of right back pain. The pain improved spontaneously, but weakness of the right upper extremity developed. The weakness deteriorated during the next month, and he was admitted to our hospital. Neurological examination disclosed impairment of superficial sensation in his right upper extremity. Blood examination showed no abnormal data. The cerebrospinal fluid was normal. Neuroradiological findings were also negative. Electrophysiological examinations were normal except for needle electromyographic findings of the right upper extremity, which showed neurogenic patterns of moderate degree. Those findings suggest neuralgic amyotrophy. However, examining the serum sample significantly elevated levels of antibody titers against Borrelia burgdorferi were observed, and we suspected that his illness was Lyme disease. He recalled, however, no arthropod bite. Neuralgic amyotrophy is a syndrome which takes a characteristic clinical course. It includes some heterogeneous disorders. On the other hand, Lyme disease, a tick-transmitted spirochetal illness, occurs in stages, with remissions and exacerbations and different clinical manifestations at each stage. The neurological abnormalities include aseptic meningitis, encephalitis, cranial neuritis, motor and sensory radiculitis, and myelitis in various combinations. They can be diagnosed serologically. However, it is possible that elevation levels of the antibody titers mean nonspecific damages of peripheral nerves. Further study is necessary to decide whether cases like ours suffer from so-called Lyme disease or not.
一名39岁男性突然出现右背部疼痛。疼痛自行缓解，但随后出现右上肢无力。在接下来的一个月里，无力症状逐渐加重，随后他被收治入院。神经学检查发现其右上肢浅感觉受损。血液检查未发现异常数据。脑脊液检查结果正常。神经放射学检查结果也为阴性。除了右上肢针电极肌电图检查结果显示为中度神经源性模式外，电生理检查均正常。这些结果提示为神经性肌萎缩。然而，检测血清样本时发现抗伯氏疏螺旋体抗体滴度显著升高，因此我们怀疑他患的是莱姆病。不过，他回忆说没有节肢动物叮咬史。神经性肌萎缩是一种具有特征性临床病程的综合征。它包括一些异质性疾病。另一方面，莱姆病是一种由蜱传播的螺旋体病，呈阶段性发作，有缓解期和加重期，且每个阶段有不同的临床表现。神经学异常包括无菌性脑膜炎、脑炎、颅神经炎、运动和感觉神经根炎以及脊髓炎等多种组合形式。这些疾病可通过血清学诊断。然而，抗体滴度升高也可能意味着外周神经的非特异性损伤。对于像我们收治的这类病例是否患有所谓的莱姆病，还需要进一步研究来确定。
