Nevroborreliose- En diagnostisk utfordring

Abstract

Neuroborreliosis (Lyme disease) is often called “The new great imitator.” In the following we will present the different clinical aspects of neuroborreliosis, which can present itself with a wide range of symptoms and findings, often making it difficult to reach the correct diagnosis.

We have tried to describe the variety of clinical manifestations presented in different cases, cases which have been reported in published articles. It is important to keep in mind neuroborreliosis as a differential diagnosis in clinical cases with unknown ethiology. Most often neuroborreliosis presents with meningitis, followed by meningoradiculitis. Frequently Bell`s palsy is seen, more seldom are paresis of the oculomotor nerve, trigeminal nerve, abduscens nerve and vestibulocochlear nerve. Peripheral radiculoneuritis with pain, paresthesia and a variety of paresis is also common. Encephalitis and myelitis is often seen at a later stage. Rarer clinical manifestations include: polyneuropathy, paresis of the phrenic nerve, ischias, acute abdominal pain, hydrocephalus, mental deficiency, sudden hearing loss and musical hallucinations, benign intracranial hypertension and internuclear ophthalmoplegia, cerebral ischemia, transient ischemic attack (TIA) and intracerebral hemorrhage.

The diagnostic process include an examination of the cerebrospinal fluid (CSF), with characteristic findings. Examination of antibodies in CSF and serum enables differentiation between active and earlier infection. ELISA is the most reliable method.

We will in this text focus on the great variety of the clinical manifestations of neuroborreliosis. It is important for doctors to be aware of this disease, so that they can make the diagnosis at an early stage, in which antibiotic treatment is curative. Failing to make the diagnosis and implementing correct treatment, may lead to serious complications and remnant symptoms for the patients.