Lyme Disease and Pseudotumor
2000; Elsevier BV; Volume: 75; Issue: 3 Linguagem: Inglês
10.1016/s0025-6196(11)65041-6
ISSN1942-5546
Autores Tópico(s)Complement system in diseases
ResumoTo the Editor. I was surprised, after reading the November 1999 Residents’ Clinic,1Worrell GA McBride KL Buchhalter JR 14-Year-old boy wilh blurred vision and diplopia.Mayo Clin Proc. 1999; 74: 1157-1160Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar that Lyme disease was not included in the differential diagnosis of increased intracranial pressure, especially since Minnesota is an endemic area for this tick-borne illness. Lyme disease may have protean neurologic manifestations, including pseudotumor; this association was first described in 1985.2Raucher HS Kaufman DM Goldfarb J Jacobson RI Roscmari B Wolff RR Pseudotumor cerebri and Lyme disease: a new association.J Pediatr. 1985; 107: 931-933Abstract Full Text PDF PubMed Scopus (57) Google Scholar Since then, I have treated 4 children, between 8 and 14 years old, with increased intracranial pressure secondary to Lyme disease. All children were seropositive by both enzyme-linked immunosorbent assay and Western blot assay at the time of their headache. Only 1 of the 4 children had previous erythema migrans. Two of the 4 had a mild lymphocytic pleocytosis (0.055, and 0.022 × 109L). Cerebrospinal fluid (CSF) opening pressures ranged from 300 to 550 mm H2O. All cranial computed tomographic scans were normal. Polymerase chain reaction (PCR) assays on the CSF were negative for Barrelia DNA in all samples, but selective intrathecal antibody production was documented in 2 of the 4 children. These 4 children with Lyme-associated pseudotumor cerebri all responded to a combination of intravenous ceftriaxone and oral acetazolamide, with resolution of their symptoms and papilledema. Certainly in Connecticut I would want to rule out this potentially treatable cause of pseudotumor. Lyme Disease and Pseudotumor: In replyMayo Clinic ProceedingsVol. 75Issue 3PreviewWe certainly agree that, in the clinical setting of increased intracranial pressure, cranial neuropathy, and CSF pleocytosis, even if “mild,” an infectious etiology would be at the top of the differential diagnosis. In general, the broad category of central nervous system (CNS) infections should be considered, and this would include Lyme disease as well as others. As stated in the Residents’ Clinic, meningitis can cause an abnormality of CSF absorption and produce hydocephalus secondary to increased intracranial pressure. Full-Text PDF Hostility and Cardiac Rehabilitation: In replyMayo Clinic ProceedingsVol. 75Issue 3PreviewIn our recent publications demonstrating marked benefits on reducing levels of hostility1 as well as other adverse behavioral characteristics (especially depression and high levels of psychological distress2–6 we used nonspecific therapy with cardiac rehabilitation and exercise training. We agree with Mr Fogel that more specific psychological treatment aimed directly at reducing high levels of behavioral abnormalities, particularly in patients with more adverse profiles or persistently abnormal profiles after cardiac rehabilitation and exercise training, would likely result in more dramatic improvements than we have noted with our nonspecific and general treatment. Full-Text PDF
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