Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children
| Autor: | N Datta, M Bjerager, A K Thielberg, J P Saunte, M H Correll, H S S Arvidsson, Michael C. Brodsky, H A Melsom |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Neurology Adolescent Eye Movements Denmark Administration Oral Enzyme-Linked Immunosorbent Assay Nystagmus Eye Infections Bacterial Sixth nerve palsy Cellular and Molecular Neuroscience Ocular Motility Disorders Ptosis CSF pleocytosis Humans Lyme Neuroborreliosis Medicine Child Pleocytosis Retrospective Studies medicine.diagnostic_test business.industry Lumbar puncture Incidence medicine.disease Antibodies Bacterial Sensory Systems Anti-Bacterial Agents Surgery Ophthalmology Borrelia burgdorferi Child Preschool Acute Disease Injections Intravenous Female medicine.symptom business |
| Zdroj: | British Journal of Ophthalmology. 99:1401-1404 |
| ISSN: | 1468-2079 0007-1161 |
| DOI: | 10.1136/bjophthalmol-2015-306855 |
| Popis: | Background Lyme neuroborreliosis (LNB) designates central nervous system involvement caused by the tick-borne spirochaete Borrelia burgdorferi (Bb). The present study describes a spectrum of acquired ocular motor disorders in children with LNB. Methods Six paediatric patients (age 3–15 years) with ocular motor symptoms as first manifestations of LNB evaluated by a paediatrician and ophthalmologist are presented. Diagnosis was based on new onset ocular motor disturbances and detection of cerebrospinal fluid (CSF) pleocytosis and intrathecal synthesis of Bb IgM and/or IgG antibodies by lumbar puncture. The children were evaluated before and after antibiotic treatment with a follow-up time of 1–7 months. Videos were obtained both pre and post treatment in four patients. Results Two children presented with acquired nystagmus, one with combined nystagmus and partial sixth nerve palsy, one with partial sixth nerve palsy, one with ptosis and one with Adie’s pupil. Five of the patients presented with severe fatigue, malaise, nausea, headache and fever. Four had recognised a tick bite recently, and two developed erythema migrans. Intrathecal synthesis of IgM and/or IgG antibodies specific for Bb was positive in all children, and five showed CSF pleocytosis. Cerebral MRI or CT of the brain were normal. Treatment with intravenous or oral antibiotics produced rapid clinical improvement in five of the six children. Conclusions LNB can present as acute ocular motor disorders in conjunction with fatigue and other clinical manifestations. In endemic areas, children with unexplained, acquired ocular motor abnormalities should be evaluated for LNB, a treatable medical condition. |
| Databáze: | OpenAIRE |
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