Neuroborreliosis Papers and References
Another serious manifestation reported is blindness (9). In 1987 we saw one patient with bilateral atrophy of the opticus nerve caused by Borrelia. The patient became almost completely blind.
Central nervous system manifestations that appear to be most common are paraparesis and ataxia. Several reports of dementia and personality changes occurring in neuroborreliosis patients have been published. One patient in the present study had loss of hearing, disorientation and change of personality.
Another way of showing the broad clinical spectrum of neuroborreliosis is by examples of how the symptoms and signs listed were interpreted by the patients and physicians before the diagnosis of neuroborreliosis was set. In our experience, patients with neuroborreliosis might appear within all medical disciplines. Radicular pain may be interpreted as abdominal pain, and when accompanied by vomiting diagnosed as gastric ulcer. In several of our patients gastroscopy has been performed. One Swedish patient was colecystectomized because of right-sided radicular pain interpreted as gall bladder disease. Other patients have been diagnosed as renal calculus and subjected to investigations of their urinary tract. Orthopedic surgeons are also likely to have contact with neuroborreliosis patients. The combination of lumbar pain and radiating pain in one leg imitates a herniated disk, and several of our patients have been investigated with CT scan and/or myeolgraphy. Cervical pain is common among patients with neuroborreliosis, and several patients have been diagnosed as having cervical rhizopathy.
The ophthalmologists must be aware that Borrelia might cause eye muscle paresis and, as mentioned above, unilateral or bilateral blindness. For the otolaryngologists neuroborreliosis is also a reality. According to Swedish investigations, Borrelia is the etiology of 15-25% of Bell's palsy cases in Sweden (11, 12) Vestibular neuritis, impaired hearing, and possibly deafness might also be caused by Borrelia.
To specialists in internal medicine neuroborreliosis might imitate stroke, but we also know of patients with neuroborreliosis who have been hospitalized with suspected myocardial infarction because of severe thoracal radicular pain. Extreme fatigue, anorexia, and loss of weight has resulted in endocrine investigations. Myalgias and athralgias might indicate rheumatological disease to the physician.
To the neurologist neuroborreliosis might appear as a multiple-sclerosis-like disease. Neuroborreliosis might also imitate brain tumor. Furthermore, the syndrome
of pseudotumor cerebri, i.e., papilloedema and high intracranial pressure with normal CSF, may have Borrelia as one of several possible etiologies." One child with this syndrome has been recognized in Sweden (study unpublished).
To specialists in infectious diseases, neuroborreliosis might appear as subacute meningitis and has most probably often been misdiagnosed as viral meningitis. One striking finding is how mild the meningitis might appear. Several patients have only slight headache and very mild discomfort, and they might look completely healthy and show no neck stiffness. Although high fever is unusual in patients with Borrelia meningitis, it may in a few patients be a dominating symptom. Patients with neuroborreliosis have been hospitalized for fever of unknown origin, and weeks have passed before a lumbar puncture has been performed and the diagnosis settled.
Different psychiatric symptoms may be associated with neuroborreliosis. Mental depression and personality changes might lead to psychiatric hospitalization. Other patients have been suspected of suffering from anorexia nervosa. One of our patients was hospitalized at an alcoholism ward for tremor, bilateral leg paresis, and change of personality. Borrelia has also been reported to cause dementia.
DIAGNOSIS
Neuroborreliosis is a great disease imitator, as can be seen from the overview given above. On the other hand, none of the symptoms discussed are specific to Borrelia, and consequently diagnostic tests are of utmost importance…