some case histories from a Lyme study 
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 some case histories from a Lyme study

Here are some notes from case histories in an article about Lyme

source:  Brain (1992), 115, 399-423
title:  The Clinical and Epidemiological Profile of Lyme Neuroborreliosis in
Denmark 1985-1990
authors:  Klaus Hansen and Anne-Mette Lebech

    "....Case Histories Illustrating Typical Features of the Common Courses of

"Case 37:  Lymphocytic meningoradiculitis (Bannwarth's syndrome)
    "A 55 year old female was admitted to a department of neurology in October
of 1985 with severe back-pain, {*filter*} diplegia and sixth nerve palsy.  Eight
weeks before she had noticed a small circular erythema with a tick in the
center over her left hip bone.  The erythema increased to a diameter of cm
within a few days and disappeared after 2 weeks.  Four weeks before admission
she experienced severe burning pains in her lower back irradiating to the left
flank and groin at night.  Three weeks later she developed a right incomplete
{*filter*} palsy, 5 d later a left nerve palsy and finally one day later a complete
{*filter*} palsy.......

"Case 2ll:  painful radiculitis without focal neurological signs
   " A 59-year old female was admitted to a surgical department in August 1990
with a 10 d history of severe deep burning pain in the right abdominal flank
irradiatiing to the back and right thigh.  A kidney stone was suspected but a
pyelogram was normal.  Over the following two months she was readmitted to a
department of internal medicine with continuous excruciating burning pain with
pronounced nocturnal exacerbation.  Three weeks before admission she had
noticed a 10x15 cm large, well-demarcated, slightly painful non-vesicular
erythema  in the right abdominal flank.  During her second admission she was
treated with morphine, aciclovir and carbamazepine as a herpes zoster neuralgia
was suspected.  None of these {*filter*} were effective.....

"Case 36:  radiculomyelitis
   " In September 1985 a 65-year old female noticed a 5x10 cm macular erythema
on her right shoulder lasting 1 week.  Two weeks later she experienced severe
burning pain in her lower neck and entire shoulder girdle, paraesthesiae in
both arms and 1 week later increasing proximal and distal paresis first of the
right arm and 2 d later of the left arm, but less pronounced. On admission to a
department of neurology she showed bilateral infranuclear paresis of shoulder,
arm and hand muscles, attenuated biceps and triceps reflexes. brisk knee and
ankle reflexes,
bilateral ankle clonus and a left Babinski's sign.  A cervical myelogram was

"Case 171:  monosymptomatic {*filter*} palsy in a child
    "....A five year old boy was admitted to a department of pediatrics in
October 1989 with a complete left {*filter*} palsy.  There was no fever, headache
or meningeal
signs.  Three weeks before he had a 1 cm broad migrating erythema expanding
from the left forehead to the left ear, transient pain around the left shoulder
and behind the left ear.  An otoneurological  examination showed loss of the
left stapedial reflex and normal taste and lacrimation.....

"Case 256:  subacute lymphocytic meningitis in a child
    "....A nine-year old boy was admitted to a department of periatrics in
November 1990.  The disease had started in July 1990 with a 14 day period of
influenza like symptoms.  During the following four months he constantly
complained of general symptoms, nausea, moderate to severe headache,
intermittent slight back pain and loss of appetite.  He had an intermittent
fever (37.5-39 degrees C) and there was a 3 kg weight loss.  The intensity of
his symptoms varied markedly from day to day.  One month before admission he
had generalized tender lymph node swelling.  On admission he showed no
meningeal signs and physical and routine laboratory examinations were

"Case 78:  chronic meningitis in an {*filter*}
    "...A 61-year-old female was admitted to a department of internal medicine
in November 1986 with a 5 week history of headache, intense pain in the neck
and shoulder girdle, dizziness, nausea, vomiting, weight loss, fatigue and
fever (38-38.5 degrees C)  Physical and routine laboratory examinations were
normal.  The back pain gradually diminished, while other symptoms persisted.
Her final weight loss was 12 kg........

"Case 129:  chronic progressive encephalo-myelitis
    "A 54-year old female was admitted to a department of neurology in March
1988 with a progressive ataxic gait disturbance.  She had been healthy until
November 1985 when she experienced a 2-3 months period with intense peain in
her neck and shoulder girdle.  She continued to have headaches, dizziness and
general symptoms.  She was admitted for the first time in February 1986.  Her
clinical examination was normal apart from a right Babinski's sign;  A CT
scanning of the brain was normal.....Audiometry showed a slight, predominately
left-sided sensorineural hearing loss.  Several months later she felt a gradual
onset of a slowly progressive impairment of gait, progressive loss of hearing
and finally an altered pattern of micturition. In January of 1988 audiometry
revealed a severe sensorineural hearing loss  involving all but especially high
frequencies; ....She was readmitted in March 1988 where she presented with
signs of a moderate, mainly right sided spastic p[araparesis.  Her gait was
broad and ataxic.  A CT scan of the brain showed periventricular lucencies and
a hypodense lesion in the left capsula interna.  ............Cystometry
revealed signs of a spastic bladder.  The tenative diagnosis was a noremitting
form of multiple sclerosis..........."

...."Painful sensory radiculitis
    "Radiculitic pain was a major symptom and present in 160 patients (86%),
beginnning 5--90 days (median 19 days) after the erythema migrans.  The
intensity of radicular pain increased significantly with the age of the
individual.  The onset was in most instances subacute, occuring overnight.
Pain often began in the region of a previous erythema migrans, then migrated
and finally became most pronounced axially in the back typically between the
shoulder blades but also in the neck or lumbar region.  Some patients had
migrating pain almost over the whole body.  The pain was described as being of
a type never experienced before and was easily distinguished from ordinary back
pains.  The intensity of the pain often varied from day to day and typically
showed severe nocturnal exacerbations(n=68).  Pain was described by most
patients as severe, burning, deep and/or superficial as if located in the skin,
and often accompanied by patchy areas of unpleasant hyper- and dysaesthesiae
(n=63).  Occasionally a belt-like sensation around the trunk was described.
Severe pain was refractory to morphine.  46 patients had radiculitic pain only
and never develfocal motor sign....
     "Before the final diagnosis of neuroborreliosis was establlished, the
painful condition was often thought due to other disease, e.g. herpes-zoster
neuralgia, cervical or lumbar nerve root compression, facet syndrome, brachial
plexus neuropathy, polymyalgia rheumatica, myocardial infarction or kidney
concrements.  In one female a cholecystectomy(gallbladder removal) was
performed, three patients underwent a biopsy of the temp{*filter*}artery, three and
iv pyelogram, seven bone scintigraphy and 17 a myelogram, before the final
    "Some patients presented with an agitated mental state....Thir{*filter*} patients
were intially suspected of being hysterical and several were examined by a
psychiatrist because of the apparent disproportion between their dramatic
complaints and the lack of signs of disease....."

from:   Everything You Need to Know About Lyme Disease by Karen
pg. 172 ---"1970---Cases of Bannwarth's cranial nerve palsy are reported, as
well as the fact that two of the patients attempted suicide because of the
    "Souce:  Wolf, G. (1970)  "Uber die chronische lymphocytare Meningitis
unter dem Bilde der Polyneuritis (Bannwarth). 'Fortschr Neurol Psychiatr,
Referenced in Weber/Burgdorfer (1993), chapter by Weber/Pfister."

Fri, 11 Aug 2000 03:00:00 GMT
 [ 1 post ] 

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