ABSTRACT
Early neurological Lyme disease (neuroborreliosis) typically presents with well-recognised neurological syndromes. Spinal myoclonus is however a rare manifestation of neuroborreliosis. We present the case of a man who developed spinal myoclonus 3 weeks after returning from the Czech Republic where he developed erythema migrans on his arm following multiple tick exposures. Spinal fluid analysis showed a pleocytosis and MRI showed enhancement at C5-C6. His serology was positive for IgM antibodies to Borrelia afzelli He was successfully treated with ceftriaxone and doxycycline with improvement of his spinal myoclonus and radiculitis. We conclude that early Lyme neuroborreliosis may present with uncommon neurological manifestations and so a high degree of suspicion is needed.
Subject(s)
Lyme Disease/diagnosis , Lyme Neuroborreliosis/complications , Myoclonus/etiology , Administration, Intravenous , Aged , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/administration & dosage , Ceftriaxone/therapeutic use , Diagnosis, Differential , Humans , Lyme Disease/cerebrospinal fluid , Lyme Disease/drug therapy , Lyme Disease/microbiology , Magnetic Resonance Imaging/methods , Male , Spinal Cord Diseases/diagnostic imaging , Spinal Cord Diseases/drug therapy , Spinal Cord Diseases/microbiology , Spinal Cord Diseases/physiopathology , Spinal Puncture/methods , Tick Bites/complications , Tick Bites/microbiology , Treatment OutcomeABSTRACT
OBJECTIVE: Intracranial tumors are rare in the first year of life. This study evaluates survival rates and functional outcomes of survivors at least 5 years after diagnosis and the predictors of this outcome. METHODS: A retrospective chart review of all infants with a primary intracranial tumor was carried out. Radiology and pathology were re-reviewed. Outcome was assessed at 5 years or more after diagnosis using Bloom's categories (Bloom 1-2 = good outcome, the rest = poor outcome) and late effects severity scoring. Age, tumor location, size, extent of tumor resection, type of adjuvant therapy given, and WHO grade of tumor histology were evaluated as predictors of outcome. RESULTS: Among 35 infants, 20 (57%) survived, with 12 (34%) having a good outcome. Deficits among the survivors included neurological dysfunction in 14 (70%), visual impairment in 9 (45%), endocrine dysfunction in 5 (25%), and auditory disability in 3 (15%). Ten of the 20 survivors were either attending regular school or were engaged in a skilled job. At presentation, older age and an infratentorial location of the tumor are predictors of poor outcome. After histopathological diagnosis, the WHO grading of tumor is the only independent predictor of survival (p = 0.002) and functional outcome (p < 0.001). CONCLUSION: About a third of the infants diagnosed with brain tumors (34%) had a good functional outcome and approximately a quarter of them (28%) were able to attend regular school or take up a skilled job. After tissue diagnosis, histological grade of tumor is the only independent predictor associated with outcome.
