RESUMEN
The paper reported the verified case of neuroboreliosis with unusual clinical presentation of Parkinsonism. Study aimed at establishing the significance of a precise differential diagnosis with substantial analysis of the symptoms of several diseases to avoid the false diagnosis and to conduct the opportune and adequate therapeutic management. We described the case of the diagnosed neuroboreliosis with clinical expression of Multiple Sclerosis (MS) and Parkinsonism. A 44 years old man was diagnosed as MS according to the McDonald's Criteria, who within two years developed typical clinical signs of Parkinsonism. Patient investigated neurologically, Brain contrast MRI (1.5 Tesla) was performed; Cerebrospinal fluid was researched for oligoclonal bands. Blood IgM and IgG were researched against Chlamidia pneumonie, Micoplasma pneumonie, Borrelia Burgdorferi, Herpes simplex 1/2, Cytomegalovirus by ELISA method. Clinically the patient expressed amimic face, oligobradikinesia, extrapiramidal rigidity in all limbs, resting tremor in upper limb fingers, horizontal nystagmus. Brain MRI showed multiple gadolinium enhanced demyelization lesions in periventricular and sub-cortical white matter. CSF oligoclonal bands were positive without dysfunction of blood-brain barrier. Blood IgM, IgG detected to be negative against Chlamidia pneumonie, Micoplasma pneumonie, cytomegalovirus, Herpes simplex ½, while the blood IgG was strongly positive against Borrelia burgdorferi, confirmed by followed Western blot test. Patient was stabilized by puls-therapy with 1 gr/intravenous Solumedrol (5 days) along with Rocephin treatment (2 gr /iv) for 21 days followed by long term treatment with Antiparkin (Carbidopa 250 mg, Levodopa 25 mg). MS and even Parkinsonism in suspicious cases should thoroughly be investigated for differentiation from chronic Neuroboreliosis.
Asunto(s)
Neuroborreliosis de Lyme/diagnóstico , Adulto , Enfermedad Crónica , Diagnóstico Diferencial , Humanos , Masculino , Esclerosis Múltiple/diagnóstico , Enfermedad de Parkinson/diagnósticoRESUMEN
Pregnancy gingivitis is developed in 30-75% of cases and it is a result of complicated hormonal and immunological changes in the organism. 100 pregnant women with various degree of severity of gingivitis have been observed. Acute generalized gingivitis, gingival edema with bleeding, hyperplasia, have been observed in all patients, while in bad cases - with ulcers' formation at gingival. Decrease of hemoreological index of gingival tissue (down to 0,15-0,19 Ohm) have been mentioned, too. Complete clinical and laboratory studies, as well as screening of obtained data have been carried out before the treatment, in its process and after the course. Pregnant women have been under the supervision, to whom according to various indications (rhesus-imcompatibility, antiphospholipidic syndrome, early interruption of pregnancy with disorder of the system of hemostasis basically towards hypercoagulation) has been carried out curative discrete plasmapheresis. All pregnant women have been diagnosed by the gingivitis of varying severity. After completion of curative course of plasmapheresis has been carried out evaluation of patients' condition. It has been reached improvement of subjective and objective data, regulation of hemoreological data in gingival tissue (0,21-0,23 Ohm). Respectively, the period of recurrence-free course of disease have been increased and the quality of patients' life have been improved.