1/17. Human granulocytic ehrlichiosis presenting as facial diplegia in a 42-year-old woman.neurologic manifestations of human ehrlichiosis are unusual and have been described almost exclusively in human monocytic ehrlichiosis associated with ehrlichia chaffeensis. We report here a case of a previously healthy 42-year-old woman who developed bilateral facial nerve palsies in association with infection by the agent of human granulocytic ehrlichiosis (aoHGE). The diagnosis was made by specific polymerase chain reaction amplification of aoHGE sequences from samples of the patient's blood and cerebrospinal fluid (CSF), as well as propagation of aoHGE in culture of HL60 cells inoculated with the patient's CSF. To our knowledge, this is the first report directly demonstrating the presence of aoHGE in CSF, and it underscores the importance of considering HGE in patients presenting with a nonspecific febrile illness and unexplained neurologic manifestations. HGE should also be considered in the differential diagnosis of bilateral facial palsy-a rare occurrence.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
2/17. optic nerve lesion following neuroborreliosis: a case report.PURPOSE: Neuroborreliosis may cause various neuro-ophthalmological complications. We describe a case with a bilateral optic neuropathy. CASE REPORT: A 58-year-old female developed facial paresis six weeks after an insect bite. One week later she developed bilateral optic disc swelling with haemorrhages and nerve fibre bundle defects in the lower visual field of the left eye. In CSF and serum, raised IgM and IgG titres to borrelia burgdorferi were found. Systemic antibiotic treatment led to improvement of the vision and facial paresis, but not all visual field defects resolved, probably due to ischemic lesions of the optic disc. DISCUSSION/CONCLUSIONS: In optic nerve lesions due to neuroborreliosis it is difficult to distinguish between inflammatory and ischemic lesions. This patient demonstrated features of an ischemic optic nerve lesion.- - - - - - - - - - ranking = 15.904386204452keywords = burgdorferi (Clic here for more details about this article) |
3/17. Ramsay Hunt syndrome: pathophysiology of cochleovestibular symptoms.Ramsay Hunt's hypothesis that herpes zoster oticus results from reactivation of the varicella zoster virus (VZV) in the geniculate ganglion is supported by the detection of viral genome in archival temporal bones of normals and Ramsay Hunt patients by the polymerase chain reaction. Ramsay Hunt syndrome is characterized by the presence of cochleovestibular symptoms in association with facial paralysis. VZV has also been demonstrated in the spiral and/or vestibular ganglion. Two cases are reported in which cochleovestibular symptoms outweighed the facial nerve symptoms, presumably representing VZV reactivation in the spiral and/or vestibular ganglion. From these observations and the known dormancy of VZV in non-neuronal satellite cells, it is argued that the cochleovestibular symptoms in Ramsay Hunt syndrome may result from VZV transmission across the nerves inside the internal auditory canal and that prompt treatment with an antiviral-corticosteroid combination might be justified in the management of any acute non-hydropic cochleovestibular syndrome.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
4/17. Bilateral simultaneous facial paralysis--differential diagnosis and treatment options. A case report and review of literature.Bilateral facial paralysis or paresis of peripheral origin is a rare condition and therefore represents a diagnostic challenge. We here present a case of a previously healthy woman who was hospitalized for symptoms of meningitis. On the second day of her hospital stay, she developed bilateral facial paresis. Later, the patient developed also tachycardia and dysrhythmias. A thorough diagnostic procedure including lumbar puncture, routine blood investigation with serological tests, MRI of the brain, Holter monitoring and transoesophageal echocardiographia, revealed meningitis with radiculitis, facial paresis and myocarditis. The clinical triad of meningitis, radiculitis and facial palsy is known as the Bannwarth syndrome (lyme disease). The patient was treated with ceftriaxone and recovered well. Despite repeatedly taken serological tests, borrelia burgdorferi immunoglobulins were not detected. Acquired bilateral facial paralysis can occur in several diseases of infectious, neurological, idiopathic, iatrogenic, toxic, neoplastic or traumatic origin. In this article, we review the differential diagnoses and treatment options of bilateral facial paresis and present a scheme that is helpful in the diagnostic evaluation of this condition.- - - - - - - - - - ranking = 15.904386204452keywords = burgdorferi (Clic here for more details about this article) |
5/17. facial nerve palsy after human herpesvirus 6 infection.facial nerve palsy has long been considered to have an infectious etiology, either viruses, mainly herpesviruses, or bacteria, such as borrelia burgdorferi. We report for the first time the association of human herpesvirus 6 and facial palsy in a previously healthy 1-year 9-month-old boy who developed left facial nerve palsy 7 days after exanthema subitum caused by human herpesvirus 6.- - - - - - - - - - ranking = 15.904386204452keywords = burgdorferi (Clic here for more details about this article) |
6/17. Varicella zoster virus: beyond facial paralysis.J. Ramsay Hunt's hypothesis that herpes zoster oticus results from a reactivation of the herpes zoster virus in the geniculate ganglion, has been supported by the demonstration of varicella zoster viral dna in the geniculate ganglion of the side with facial paralysis in patients with Ramsay Hunt syndrome, with the use of the polymerase chain reaction. Similarly, dna of the varicella zoster virus has been identified in the spiral and vestibular ganglion as well. We report on three patients with cochleovestibular symptoms as the first manifestations of Ramsay Hunt syndrome. A 64-year old woman and a 72-year old man presented with vertigo and an auricular herpetiform eruption. Only the woman developed later on a mild facial paralysis. A 58-year old man presented with an acute cochleovestibular syndrome, serologically proven to be a varicella zoster viral reactivation, which was followed three weeks later by the typical cutaneous recrudescence. We believe that these cases result from reactivation of latent varicella zoster virus in the spiral and/or vestibular ganglion. As the varicella zoster virus is dormant in the non-neuronal satellite cells, the facial symptoms in our patients as well as the high incidence of cochleovestibular symptoms in classical Ramsay Hunt syndrome can be explained by viral transmission across the nerves inside the internal auditory canal. Therefore, we think there are grounds to recommend a prompt treatment with an antiviral and a corticosteroid agent, not only in case of an acute facial paralysis but also when confronted with an acute cochleovestibular syndrome.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
7/17. Bilateral facial palsy: Epstein-Barr virus, not lyme disease.Bilateral facial palsy is frequently linked with lyme disease. We report a patient with bilateral facial palsy due to Epstein-Barr virus infection but with borrelia burgdorferi IgM in serum caused by polyclonal B-lymphocyte stimulation.- - - - - - - - - - ranking = 32.362456734932keywords = burgdorferi, lyme disease, lyme (Clic here for more details about this article) |
8/17. Facial palsy with elevated protein in otherwise normal CSF in a child with lyme disease.This is a report on an eight-year-old girl who presented with facial palsy, headache, fatigue, arthralgias and myalgias six weeks after two tick bites. physical examination was unremarkable with the exception of a left-sided facial palsy. Laboratory investigation revealed normal complete blood count, ESR and CRP. The spinal tap showed a protein of 63 mg/dl, glucose 45 mg/dl and no cells. IFT titres to borrelia burgdorferi in serum and CSF were significantly elevated. The diagnosis was supported by Western blot analysis. Treatment was started with ceftriaxone i.v. for a total of 14 days. Under this therapeutic regimen the patient improved substantially within five days. Investigation of CSF in patients with facial palsy may help to establish the diagnosis of lyme disease by simultaneously measuring IFT to B. burgdorferi in serum and spinal fluid, even in cases where CSF shows little or no signs of inflammation.- - - - - - - - - - ranking = 31.808772408905keywords = burgdorferi (Clic here for more details about this article) |
9/17. Cogan's syndrome and seroreactivity to Lyme borreliosis.We document the case of a young woman with bilateral nonluetic, interstitial keratitis, vestibuloauditory problems, and bilateral recurrent facial palsies, who had strongly positive serologic tests of Lyme borreliosis. To our knowledge, this is the first reported case of positive serologic tests for borrelia burgdorferi in a patient with Cogan's syndrome.- - - - - - - - - - ranking = 15.904386204452keywords = burgdorferi (Clic here for more details about this article) |
10/17. The neurological complications of borrelia burgdorferi in the New Forest area of Hampshire.The neurological complications of borrelia burgdorferi infection have only recently been recognised in the United Kingdom. Eight cases are reported which were all contracted in the New Forest area of Hampshire. The majority of patients had Bannwarth's syndrome though meningism and parenchymal lesions also occurred. All patients made a virtually complete neurological recovery in contrast to some patients with lyme disease.- - - - - - - - - - ranking = 79.521931022262keywords = burgdorferi (Clic here for more details about this article) |
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