Ramgopal Sriram, Obeid Rawad, Zuccoli Giulio, Cleves-Bayon Catalina, Nowalk Andrew
Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, 4401 Penn Avenue, AOB 5400, Pittsburgh, PA, 15224, USA.
Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Neurol. 2016 Mar;263(3):500-7. doi: 10.1007/s00415-015-8007-x. Epub 2016 Jan 6.
Lyme disease (LD) is a tick-borne infection that is endemic to multiple areas of the United States. Patients with LD may present with sign and symptoms of intracranial hypertension (IH). The objective of this study is to evaluate the history, clinical findings, CSF analysis, and brain imaging results in pediatric patients with increased intracranial pressure secondary to LD. A retrospective database search was performed using the International Classification of Diseases (ICD) 9/10 codes to identify patients diagnosed with LD and IH between 2004 and 2014 at a tertiary referral pediatric hospital. Clinical, laboratory and neuroimaging data for each patient were reviewed. Seven patients met inclusion criteria; mean age was 9.6 years (standard deviation 4.0 years); 4/7 patients were male. Average body mass index was 18.8 kg/m(2) (standard deviation 3.0 kg/m(2)). Fever was present in four patients. Four had a history of LD related erythema migrans. All had elevated CSF opening pressure with leukocytosis and lymphocytic predominance. MRI obtained in six patients showed contrast enhancement of various cranial nerves. Tentorial enhancement was noted in all patients. In addition, patients had widening of the optic nerve sheath (ONS), optic nerve protrusion, and flattening of the posterior globe consistent with increased intracranial pressure. All patients had resolution of their symptoms after initiation of antibiotic therapy. In endemic areas, LD should be included in the differential of IH. MRI can help distinguish IH due to LD from its idiopathic form due to the presence of tentorial and cranial nerve enhancement in the former in addition to abnormal CSF showing leukocytosis with lymphocyte predominance.
莱姆病（LD）是一种由蜱传播的感染性疾病，在美国多个地区流行。莱姆病患者可能出现颅内高压（IH）的体征和症状。本研究的目的是评估继发于莱姆病的小儿颅内压升高患者的病史、临床发现、脑脊液分析和脑成像结果。利用国际疾病分类（ICD）9/10编码对一家三级转诊儿科医院2004年至2014年间诊断为莱姆病和颅内高压的患者进行回顾性数据库搜索。对每位患者的临床、实验室和神经影像学数据进行了审查。七名患者符合纳入标准；平均年龄为9.6岁（标准差4.0岁）；4/7的患者为男性。平均体重指数为18.8kg/m²（标准差3.0kg/m²）。四名患者出现发热。四名患者有与莱姆病相关的游走性红斑病史。所有患者脑脊液初压升高，伴有白细胞增多且以淋巴细胞为主。六名患者的MRI显示各种颅神经有强化。所有患者均有小脑幕强化。此外，患者视神经鞘（ONS）增宽、视神经突出以及眼球后部变平，符合颅内压升高表现。所有患者在开始抗生素治疗后症状均得到缓解。在流行地区，莱姆病应列入颅内高压的鉴别诊断中。MRI有助于将莱姆病所致的颅内高压与特发性颅内高压区分开来，因为前者除了脑脊液异常显示白细胞增多且以淋巴细胞为主外，还存在小脑幕和颅神经强化。
