Cervical Radiculitis as Initi al Clinical Fe ature of Ne uroborreli osis – Case Reports

Česká verzia

Authors: L. Gurčík; A. Tomášová; O. Benc; P. Galik; V. Gašparíková; P. Kubaľová; S. Lišková
Authors place of work: Ne urologické oddeleni e VNsP Levoča, a. s.
Published in the journal: Cesk Slov Neurol N 2009; 72/105(3): 255-259
Category: Case Report

Summary

The most common ca uses of cervical radicular syndromes are oste oproductive changes of cervical spine (68%) and disc herni ati ons (22%). The di agnosis of oste odiscogenic radicular syndrome is supported by ne uro imaging findings (the method of cho ice is MRI), electrophysi ological examinati ons and other methods. In 10 % of cases the eti ology of cervical radicular syndrome is other than discogenic. This possibility sho uld be remembered, when the co urse of dise ase is atypical, there is no correlati on between clinical symptoms and ne uro image findings and standard tre atment is ineffective. In o ur article, two case reports of pati ents with Lyme dise ase are presented, in which the initi al clinical symptomatology resembled discogenic radicular syndrome. The first pati ent later developed spinal symptoms with fast progressi on. In order to rule o ut primary or secondary spinal tumor, bi opsy of intramedular expansi on was performed with a noncharacteristic histological finding. Di agnosis in the second pati ent was supported by development of bilateral peripheral faci al palsy and other ne urological symptoms. High titers of antibodi es in serum and cerebrospinal fluid in both pati ents led to the final di agnosis of Lyme dise ase.

Key words:
cervical radiculitis – ne uroborreli osis – Garin‑Bujado ux- Bannwarth syndrome

Zdroje

1. Radhakrishnan K, Litchy WJ, O‘Fallon WM, Kurland LT. Epidemi ology of cervical radiculopathy. A populati on‑based study from Rochester, Minnesota, 1976 thro ugh 1990. Brain 1994; 117(2): 325– 335.

2. Wormser GP. Clinical practice. Early type dise ase. N Engl J Med 2006; 354(26): 2794– 2801.

3. Bartůněk P et al. Lymeská boreli óza. Praha: Grada Publishing 2006.

4. Hattingen E, Weida uer S, Ki eslich M, Boda V, Zanella FE. MR imaging in ne uroborreli osis of the cervical spinal cord. Eur Radi ol 2004; 14(11): 2072– 2075.

5. Chani er S, La uxero is M, Ri e u V. Back pain witho ut radiculitis as an initi al manifestati on of Lyme dise ase: two cases. Presse Med 2007; 36(1): 61– 63.

6. Ljøstad U, Mygland A. CSF B‑lymphocyte chemo attractant (CXCL13) in the e arly di agnosis of acute Lyme ne uroborreli osis. J Ne urol 2008; 255(5): 732– 737.

7. Agosta F, Rocca MA, Benedetti, Capra R, Cordi oli C, Filippi M. MR imaging assessment of brain and cervical cord damage in pati ents with ne uroborreli osis. Am J Ne uroradi ol 2006; 27(4): 992– 994.

8. Murthy JM, Reddy JJ, Meena AK, Ka ul S. Acute transverse myelitis: MRI characteristics. Ne urol Indi a 1999; 47(4): 290– 293.

9. Opavský R, Kubát A. Akutní myelitida s obrazem Brown- Séqu ardova syndromu. Cesk Slov Ne urol N 2004; 67/ 100(3): 193– 195.

10. Bojar M. Obrna lícního nervu. Cesk Slov Ne urol N 2007; 70/ 103(6): 613– 624.

11. Kerr D. Transverse myelitis. In: Johnson RT, Griffin JW, Mc Arthur JC (eds). Current therapy in ne urologic dise ase. 6th ed. New York: Mosby Press 2001: 176– 180.

12. Weissenbacher S, Ring J, Hofmann H. Gabapentin for the symptomatic tre atment of chronic ne uropathic pain in pati ents with late‑stage lyme borreli osis: a pilot study. Dermatology 2005; 211(2): 123– 127.

13. Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS et al. The clinical assessment, tre atment, and preventi on of Lyme dise ase, human granulocytic anaplasmosis, and babesi osis: clinical practice guidelines by the Infecti o us Dise ases Soci ety of America. Clin Infect Dis 2006; 43(9): 1089– 1134.