Case studyUncommon manifestations of neuroborreliosis in children
Introduction
Lyme borreliosis is a tick-borne infection and in Europe caused by at least four species of the spirochete Borrelia burgdorferi sensu lato (B. burgdorferi sensu stricto, B. afzelii, B. garinii and B. spielmanii). It presents as a multisystem disease involving the skin, nervous system, joints and heart. Children with neuroborreliosis commonly have a peripheral facial nerve palsy or aseptic meningitis, but the spectrum includes other rare manifestations. Additionally the laboratory diagnosis of neuroborreliosis can be challenging. The diagnostic criteria of the German Neurological Society (DGN) for a secured neuroborreliosis include the typical clinical symptoms such as meningism or facial nerve palsy, CSF pleocytosis and an elevated specific B. burgdorferi CSF to serum antibody index (AI), or the detection of B. burgdorferi by culture or PCR.
To draw attention to the wide range of neurologic manifestations of infections with B. burgdorferi we present four unusual cases of neuroborreliosis in children.
Section snippets
Case 1
A 6 year old boy was admitted for further work up because of two epileptic seizures. The first episode occurred two days prior to admission when he suddenly fell to the ground while playing. He was unable to move his left arm and leg for several minutes, but was fully alert. On the day of admission he fell again and started twitching with all four extremities with the head turned to the right. This was followed by a postictal left sided hemiparesis lasting an hour.
Initial physical and
Discussion
Here we present four children with a neuroborreliosis, which were diagnostically challenging because of their unusual presentation.
The first child presented with focal and secondary generalised seizures and regional leptomeningeal enhancement over one hemisphere. Epileptic seizures in children in the course of neuroborreliosis have only been sporadically described, mostly in conjunction with parenchymatous lesions or a meningoencephalitis.1, 2, 3 A vasculitis is thought to be the primary
References (14)
- et al.
Lyme disease with lymphocytic meningitis, trigeminal palsy and silent thalamic lesion
Europ J Paediatr Neurol
(2008 Nov) - et al.
Opsoclonus-myoclonus syndrome in a child with neuroborreliosis
J Infect
(2000) - et al.
Epidemiology and clinical manifestations of Lyme borreliosis in childhood. A prospective multicentre study with special regard to neuroborreliosis
Acta Paediatr Suppl
(1993) - et al.
Primarily chronic and cerebrovascular course of Lyme neuroborreliosis: case reports and literature review
Arch Dis Child
(2000) - et al.
Lyme disease: acute focal meningoencephalitis in a child
Pediatrics
(1988) - et al.
MRI in Lyme disease of the spinal cord
Neuroradiology
(2001) - et al.
Lyme disease in childhood presenting as primary leptomeningeal enhancement without parenchymal findings on MR
AJNR Am J Neuroradiol
(1994)
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2015, Neuroimaging Clinics of North AmericaCitation Excerpt :These organisms more commonly involve the cranial meninges. In addition, many other species can be isolated from spinal meninges.8–12 Common and uncommon pathogens are also reported as the cause of abscess and meningitis following surgery or trauma to the spinal cord.5,10,11