tailieunhanh - Neuromuscular Diseases A Practical Guideline - part 7

Tham khảo tài liệu 'neuromuscular diseases a practical guideline - part 7', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | 284 Bacterial and parasitic neuropathies Genetic testing NCV EMG Laboratory Imaging Biopsy Borrelia Burgdorferi Lyme disease Clinical syndrome signs Pathogenesis The earliest stage of Lyme disease stage I is characterized by the unique skin rash and symptoms of general infection. Neuroborreliosis begins in stage II of the disease. In stage II disease the most common occurrence is lymphocytic meningoradi-culitis. Motor and sensory symptoms may occur variably and undulate in severity over the course of months. Half of patients have focal or multifocal cranial nerve disease including the facial trigeminal optic vestibulocochlear and oculomotor nerves. Late stage II disease involves distal symmetric sensory neuropathy and encephalomyelitis lasting for weeks or months. Motor signs are rare. Asymmetric oligoarthritis cardiac impairment and myositis can occur alongside a variety of CNS conditions in stage III disease. Demyelination and subacute encephalitis may be accompanied by ataxia spastic paraparesis bladder dysfunction cognitive problems and dementia. Lyme disease sometimes known as Bannwarth s syndrome in Europe is caused by infection with the Borrelia Burgdorferi spirochete. The infection is transmitted by bites from the Ixodes dammini scapularis and pacificus tick species. The cause of peripheral neuropathy following infection is unclear although there is cross reactivity between spirochete antigens and epitopes from Schwann cells and PNS axons. Diagnosis Serology commonly leads to false positives. A combination of ELISA and Western blot of CSF and serum is more reliable. PCR of blood and CSF is the most specific method and can be used for difficult cases. Therapy Antibiotics are important both for eradication of the infection and quick resolution of painful symptoms. The usefulness of steroids for pain management is not clear at this point. Prognosis Antibiotic therapy typically leads to resolution of neurological symptoms in a few weeks to months. This is trial