ABSTRACT
Forty-seven patients with the late borrelial manifestation acrodermatitis chronica atrophicans (ACA) and with objective neurological and/or neurophysiological findings were followed up after antibiotic treatment with dermatological, serological, neurological and neurophysiological controls. Despite a good therapeutic effect on ACA lesions, specific antibody values and symptoms of irritative nerve lesions, the objective neurological and neurophysiological findings of nerve deficit remained unchanged. There was no progress of neuropathy findings during the follow-up time. Our interpretation of the results is that the remaining neuropathy signs after treatment of ACA are neurological sequelae and not manifestations of persisting Borrelia infection.
Subject(s)
Acrodermatitis/complications , Acrodermatitis/drug therapy , Anti-Bacterial Agents/therapeutic use , Borrelia burgdorferi/pathogenicity , Cefuroxime/therapeutic use , Doxycycline/therapeutic use , Lyme Disease/complications , Lyme Disease/drug therapy , Penicillins/therapeutic use , Peripheral Nervous System Diseases/drug therapy , Peripheral Nervous System Diseases/etiology , Acrodermatitis/physiopathology , Adult , Aged , Aged, 80 and over , Borrelia burgdorferi/drug effects , Female , Follow-Up Studies , Humans , Lyme Disease/physiopathology , Male , Middle Aged , Peripheral Nervous System Diseases/physiopathology , Prospective Studies , Time FactorsABSTRACT
In a prospective study, detailed clinical and neurophysiological examinations were performed in 17 patients with polyneuropathy associated with the late borrelial manifestation acrodermatitis chronica atrophicans (ACA). Similar clinical and neurophysiological signs were found in most of the patients. The findings were those of a sensory polyneuropathy, mainly affecting large nerve fibres. Marked abnormality of vibration threshold was a common finding and in 4 patients this raised a suspicion of spinal cord engagement, in addition to a polyneuropathy. Sural nerve biopsy, performed in 3 of the patients, showed a mainly axonal neuropathy. Biopsy findings did not confirm earlier reports of vasculitis of epineural vessels in ACA-associated polyneuropathy.
Subject(s)
Lyme Disease/diagnosis , Polyneuropathies/diagnosis , Acrodermatitis/diagnosis , Acrodermatitis/pathology , Acrodermatitis/physiopathology , Aged , Aged, 80 and over , Axons/pathology , Axons/physiology , Biopsy , Female , Humans , Lyme Disease/pathology , Lyme Disease/physiopathology , Male , Nerve Fibers/pathology , Nerve Fibers/physiology , Neurologic Examination , Polyneuropathies/pathology , Polyneuropathies/physiopathology , Sural Nerve/pathology , Sural Nerve/physiopathology , Vasa Nervorum/pathology , Vasa Nervorum/physiopathology , Vasculitis/diagnosis , Vasculitis/pathology , Vasculitis/physiopathologyABSTRACT
Clinical and/or neurophysiological signs of peripheral neuropathy were found in 64% of 63 consecutive untreated patients with the late borrelial manifestation acrodermatitis chronica atrophicans (ACA). The neuropathy frequency was significantly higher in the patients than in 30 age- and sex-matched control persons of whom 27% had neuropathy findings. The most common neuropathy in ACA was a symmetric distal sensory polyneuropathy. In a subgroup of patients with localized or asymmetric neuropathy, the changes were found more often in extremities with than without visible ACA lesions. Neuropathy symptoms, most often pain and/or paresthesia, were present in 64% of the patients, compared to in 13% of the control persons. Thus, both symptoms and signs of neuropathy were significantly more frequent in patients with untreated ACA than in control subjects.
Subject(s)
Acrodermatitis/epidemiology , Lyme Disease/complications , Peripheral Nervous System Diseases/epidemiology , Acrodermatitis/microbiology , Acrodermatitis/pathology , Adult , Age Factors , Aged , Borrelia burgdorferi Group/isolation & purification , Case-Control Studies , Chi-Square Distribution , Comorbidity , Extremities/pathology , Extremities/physiopathology , Female , Humans , Hyperalgesia/pathology , Hyperalgesia/physiopathology , Hypesthesia/pathology , Hypesthesia/physiopathology , Male , Middle Aged , Pain/classification , Pain/pathology , Pain/physiopathology , Paresthesia/pathology , Paresthesia/physiopathology , Peripheral Nervous System Diseases/etiology , Peripheral Nervous System Diseases/pathology , Peripheral Nervous System Diseases/physiopathology , Prevalence , Prospective Studies , Risk Factors , Sex Factors , Sweden/epidemiologyABSTRACT
In a 2-year study of 37 consecutive adult patients with isolated cranial nerve affection of primarily unknown origin, seen at a neurological clinic, borrelia infection was identified as the cause in six cases. Four patients had a peripheral facial palsy and two had a sixth nerve palsy. The patients with borreliosis had headaches or other pain considerably more often than patients with other or unknown aetiology. All six patients had accompanying symptoms and/or signs; in five cases these were obvious, and pointed to a borrelia infection. This study indicates that a careful history to elicit other symptoms of Lyme borreliosis will usually identify the cranial nerve affections with borrelial aetiology in adult patients. To verify the diagnosis, both serum and CSF analysis should be performed. Routine testing for borrelia serology in all patients with cranial neuropathy is generally not indicated.
Subject(s)
Cranial Nerve Diseases/etiology , Lyme Disease/complications , Adult , Aged , Aged, 80 and over , Cranial Nerve Diseases/diagnosis , Female , Humans , Lyme Disease/drug therapy , Male , Middle Aged , Prospective Studies , Risk Factors , Treatment OutcomeABSTRACT
In a study of 94 consecutive patients with neurophysiologically verified carpal tunnel syndrome (CTS) 7/94 had IgG and 0/94 IgM serum titers to Borrelia burgdorferi above the 98th percentile value of age and sex matched controls (n = 127). The difference in prevalence of positive IgG serum titers in patients, compared to controls, was not statistically significant. Even in patients, living in an area, highly endemic for Lyme borreliosis, routine serological screening for borrelia infection does not seem indicated in the investigation of CTS.
Subject(s)
Acrodermatitis/immunology , Antibodies, Bacterial/analysis , Borrelia burgdorferi Group/immunology , Carpal Tunnel Syndrome/immunology , Lyme Disease/immunology , Acrodermatitis/diagnosis , Adult , Aged , Aged, 80 and over , Carpal Tunnel Syndrome/diagnosis , Erythema Chronicum Migrans/diagnosis , Erythema Chronicum Migrans/immunology , Female , Follow-Up Studies , Humans , Immunoglobulin G/analysis , Lyme Disease/diagnosis , Male , Middle AgedABSTRACT
Low grade gliomas were studied with ultra low field magnetic resonance imaging (ULF MRI). The tumors exhibited high tissue contrast in both T1 and T2-weighted images as compared to normal brain tissue. Moreover they were sharply delineated towards the surrounding brain tissue. When compared with X-ray computed tomography the tumors were more readily detected and delineated by using ultra-low field magnetic imaging. A computer-assisted classification procedure was used to define new regions of interest for relaxation time estimations. By using this procedure more accurate estimations of the T1 and T2 values were obtained.
