Ebner Derek, Smith Kelsey, DeSimone Daniel, Sohail Muhammad Rizwan
Division of General Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
Division of Neurology, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
BMJ Case Rep. 2018 Jan 23;2018:bcr-2017-223307. doi: 10.1136/bcr-2017-223307.
A 61-year-old man presented to the emergency department in the summer with a right seventh cranial nerve lower motor neuron palsy and worsening paraesthesias for 6 weeks. He had debilitating pain at the scalp and spine. Prior work up was unrevealing. The patient resided in the upper Midwest region of the USA and worked outdoors, optimising the landscape for white tailed deer. Repeat cerebrospinal fluid testing revealed a lymphocytic pleocytosis and positive IgM Lyme serology. Brain MRI demonstrated enhancement of multiple cranial nerves bilaterally. He was diagnosed with early Lyme neuroborreliosis and treated with 28 days of intravenous ceftriaxone. While the painful meningoradiculitis, also known as Bannwarth syndrome, is more commonly seen in Europe, facial palsy is more frequently encountered in the USA. Clinical manifestations of neuroborreliosis are important to recognise as the classic presentation varies by geography and on occasion repeat serological testing may be necessary.
一名61岁男性于夏季因右侧第七颅神经下运动神经元麻痹及感觉异常加重6周就诊于急诊科。他头皮和脊柱疼痛难忍。之前的检查未发现异常。该患者居住在美国中西部上游地区，从事户外工作，负责优化白尾鹿的栖息地。重复脑脊液检测显示淋巴细胞增多，IgM型莱姆血清学呈阳性。脑部磁共振成像显示双侧多条颅神经强化。他被诊断为早期莱姆神经疏螺旋体病，并接受了28天的静脉注射头孢曲松治疗。虽然疼痛性脑脊神经根炎，也称为班沃特综合征，在欧洲更为常见，但面瘫在美国更为常见。神经疏螺旋体病的临床表现很重要，因为其典型表现因地域而异，有时可能需要重复进行血清学检测。
