Pachner A R
Department of Neurology, University Hospital, Georgetown University Medical School, Washington, D.C. 20007.
Rev Infect Dis. 1989 Sep-Oct;11 Suppl 6:S1482-6.
The causative agent of Lyme disease, Borrelia burgdorferi, is a highly neurotropic organism that not only can produce symptomatic neurologic disease but also can exist dormant within the central nervous system (CNS) for long periods. Two distinct types of neuroborreliosis occur at different stages of Lyme disease. Second-stage Lyme meningitis resembles aseptic meningitis and is often associated with facial palsies, peripheral nerve involvement, and/or radiculopathies. Lyme meningitis may be the first evidence of Lyme disease, occurring without a history of erythema chronicum migrans or flu-like illness. Third-stage parenchymal involvement causes a multitude of nonspecific CNS manifestations that can be confused with conditions such as multiple sclerosis, brain tumor, and psychiatric derangements. Manifestations of CNS parenchymal involvement in Lyme disease are generally associated, however, with a history of erythema chronicum migrans, meningitis, or carditis. Both second- and third-stage Lyme neuroborrelioses are commonly misdiagnosed because they are relatively uncommon and because they mimic many better-known disorders.
莱姆病的病原体伯氏疏螺旋体是一种高度嗜神经的微生物，它不仅能引发有症状的神经疾病，还能在中枢神经系统（CNS）中长期潜伏。莱姆病的不同阶段会出现两种不同类型的神经型伯氏疏螺旋体病。第二阶段的莱姆脑膜炎类似于无菌性脑膜炎，常伴有面瘫、周围神经受累和/或神经根病。莱姆脑膜炎可能是莱姆病的首个迹象，在没有慢性游走性红斑或流感样疾病病史的情况下出现。第三阶段的实质受累会导致多种非特异性的中枢神经系统表现，这些表现可能会与多发性硬化症、脑肿瘤和精神错乱等病症相混淆。然而，莱姆病中枢神经系统实质受累的表现通常与慢性游走性红斑、脑膜炎或心肌炎病史相关。第二阶段和第三阶段的莱姆神经型伯氏疏螺旋体病都常被误诊，因为它们相对不常见，且症状与许多更常见的疾病相似。
