RESUMEN
Lyme's disease, transmitted by Borrelia Burgdorferi (BB), is a polymorphic and multisystemic illness. Its neurological manifestations are encountered in 10-50% of cases and occur in the acute disseminated stage as well as in the late stage. This article initially reviews the principal clinical pictures of the neuroborreliosis and distinguishes them from neurological disorders whose association with BB infection is not proven. The paper then discusses the relative usefulness of the different ancillary tests in the diagnostic workup. We hope to stimulate interest in the research of intrathecal specific antibody production (especially in the early central nervous system diseases), instead of measuring levels of anti-BB antibodies in the serum and in the cerebrospinal fluid. Finally, a treatment plan is proposed, whose efficiency constitutes another argument in favor of the correct diagnosis but whose failure may reflect a diagnostic error.
Asunto(s)
Grupo Borrelia Burgdorferi/inmunología , Enfermedades del Sistema Nervioso Central/microbiología , Enfermedad de Lyme/diagnóstico , Anciano , Anciano de 80 o más Años , Anticuerpos Antibacterianos/líquido cefalorraquídeo , Anticuerpos Antibacterianos/aislamiento & purificación , Enfermedades de los Nervios Craneales/microbiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Enfermedad de Lyme/inmunología , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso Periférico/microbiología , Reacción en Cadena de la Polimerasa , Polirradiculoneuropatía/microbiologíaRESUMEN
The results of a retrospective study on 835 patients in which brain scan was performed during their ambulant and clinical examination are presented. In 18.6% of the cases the scan gave correct results which highly determined the further diagnostic procedure. In 37.5% of the cases the radioisotope brain scan revealed positive results which besides other findings contributed to the decision on the further diagnostic procedure. In 30.5% of the cases the results of the scan were correct but of low diagnostic value, since the further procedure was determined by other diagnostic methods. In 7.4% of the cases the brain scan gave false positive results indicating a focal brain lesion. In these cases the cerebral scintigraphy gave rise to redundant and riskful neuroradiological investigations. In 1.8% of the cases in which retrospectively a threatening brain lesion could be established, the brain scan gave false negative results. The results of this investigation indicate that brain scanning although being a harmless diagnostic method, can induce redundant and riskful further examination. The application of isotope brain scan as diagnostic procedure requires a precise indication even more so, since computerized transverse axial tomography, a harmless screening method of high resolution is now available.
Asunto(s)
Encefalopatías/diagnóstico , Cintigrafía/métodos , Absceso Encefálico/diagnóstico , Neoplasias Encefálicas/diagnóstico , Reacciones Falso Negativas , Reacciones Falso Positivas , Hematoma Subdural/diagnóstico , Humanos , Metástasis de la Neoplasia , Cuidados PreoperatoriosRESUMEN
In 248 patients with vagovasal syncope, EEGs recorded during a seizure free period showed abnormality in 19.3% of the cases. In 2% there were only nonspecific disturbances of background activity. 12.9% (during the resting record 9.7%) of the investigated persons showed paroxysmal slower and/or sharper transients and a further 4.4% (in the resting record 2.4%) hypersynchronous activity, which occurred significantly more often in women than in men. It also usually consisted of single fine spikes or sharp waves and only rarely did real sharp and slow-wave complexes or abortive spike-waves appear. Two patients (one with a normal and the other with an abnormal record) had spontaneous syncopal attacks during the EEG recording, showing in the EEG as generalized high voltage delta waves, which in one case changed into a transitory isoelectric trace. These EEG changes were similar to those in provoked vagovasal syncope, as described by other authors. EEG transients in patients with clinical vagovasal syncope are discussed. In the rare cases with very pronounced EEG changes, a neurological examination is advisable for complete assessment of the case. In patients with otherwise typical vagovasal syncope, long-term anticonvulsive therapy merely because of dyrhythmic transients and/or single fine spikes in the seizure-free period is, in the opinion of the author, not indicated.