Pfadenhauer K, Schönsteiner T, Stöhr M
Neurologische Klinik mit klinischer Neurophysiologie, Zentralklinikum Augsburg.
Nervenarzt. 1998 Apr;69(4):296-9. doi: 10.1007/s001150050273.
In the past little attention was paid to the thoracoabdominal manifestation of Lyme radiculoneuritis, because paralysis of the abdominal wall muscles was considered to be a very uncommon clinical manifestation of Lyme neuroborreliosis. In a group of 90 patients suffering from early stage Lyme neuroborreliosis we found abdominal wall weakness in 11 cases. In the majority of patients thoracoabdominal radiculoneuritis was located in the lower thoracic segments (Th 7-12) and involved more than 3 segments (62%) mostly bilaterally (69%). Abdominal wall paralysis was mostly bilateral (91%) and involved always the lower half of the abdominal wall. It was very severe in 18%. Electromyographic studies were done in the paraspinal and abdominal wall muscles showing fibrillation potentials and positive sharp waves in 86% and 50%, respectively. Diagnosis of thoracoabdominal radiculoneuritis in Lyme neuroborreliosis may be difficult and diagnostic errors may occur. Therefore we recommend to look carefully for paralysis of the abdominal wall, which can easily be overlooked on routine neurological examination. In patients from an area with a high incidence of Lyme disease it is recommended to exclude neuroborreliosis even in patients with known diabetes mellitus in order to avoid the misdiagnosis of diabetic thoracoabdominal radiculopathy. This has occured in 2 of our patients.
过去，人们很少关注莱姆神经根神经炎的胸腹表现，因为腹壁肌肉麻痹被认为是莱姆神经疏螺旋体病非常罕见的临床表现。在一组90例早期莱姆神经疏螺旋体病患者中，我们发现11例存在腹壁无力。大多数患者的胸腹神经根神经炎位于胸下段（Th 7 - 12），累及超过3个节段（62%），大多为双侧受累（69%）。腹壁麻痹大多为双侧性（91%），且总是累及腹壁下半部。18%的患者病情非常严重。对椎旁肌和腹壁肌肉进行了肌电图研究，结果分别显示86%和50%的患者有纤颤电位和正锐波。莱姆神经疏螺旋体病中胸腹神经根神经炎的诊断可能困难，且可能出现诊断错误。因此，我们建议仔细检查腹壁麻痹情况，这在常规神经系统检查中很容易被忽视。对于来自莱姆病高发地区的患者，即使是已知患有糖尿病的患者，也建议排除神经疏螺旋体病，以避免误诊为糖尿病性胸腹神经根病。我们的2例患者就出现了这种情况。
