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Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children.
Br J Ophthalmol. 2015 Oct; 99(10):1401-4.BJ

Abstract

BACKGROUND

Lyme neuroborreliosis (LNB) designates central nervous system involvement caused by the tick-borne spirochaete Borrelia burgdorferi (Bb). The present study describes a spectrum of acquired ocular motor disorders in children with LNB.

METHODS

Six paediatric patients (age 3-15 years) with ocular motor symptoms as first manifestations of LNB evaluated by a paediatrician and ophthalmologist are presented. Diagnosis was based on new onset ocular motor disturbances and detection of cerebrospinal fluid (CSF) pleocytosis and intrathecal synthesis of Bb IgM and/or IgG antibodies by lumbar puncture. The children were evaluated before and after antibiotic treatment with a follow-up time of 1-7 months. Videos were obtained both pre and post treatment in four patients.

RESULTS

Two children presented with acquired nystagmus, one with combined nystagmus and partial sixth nerve palsy, one with partial sixth nerve palsy, one with ptosis and one with Adie's pupil. Five of the patients presented with severe fatigue, malaise, nausea, headache and fever. Four had recognised a tick bite recently, and two developed erythema migrans. Intrathecal synthesis of IgM and/or IgG antibodies specific for Bb was positive in all children, and five showed CSF pleocytosis. Cerebral MRI or CT of the brain were normal. Treatment with intravenous or oral antibiotics produced rapid clinical improvement in five of the six children.

CONCLUSIONS

LNB can present as acute ocular motor disorders in conjunction with fatigue and other clinical manifestations. In endemic areas, children with unexplained, acquired ocular motor abnormalities should be evaluated for LNB, a treatable medical condition.

Authors+Show Affiliations

Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Ophthalmology, Copenhagen University Hospital Glostrup, Glostrup, Denmark.Department of Ophthalmology, Copenhagen University Hospital Glostrup, Glostrup, Denmark.Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark.Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark.Department of Pediatrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark.Department of Pediatrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark.Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Ophthalmology, Copenhagen University Hospital Glostrup, Glostrup, Denmark.

Pub Type(s)

Case Reports
Journal Article
Video-Audio Media

Language

eng

PubMed ID

25868792

Citation

Correll, M H., et al. "Lyme Neuroborreliosis: a Treatable Cause of Acute Ocular Motor Disturbances in Children." The British Journal of Ophthalmology, vol. 99, no. 10, 2015, pp. 1401-4.
Correll MH, Datta N, Arvidsson HS, et al. Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children. Br J Ophthalmol. 2015;99(10):1401-4.
Correll, M. H., Datta, N., Arvidsson, H. S., Melsom, H. A., Thielberg, A. K., Bjerager, M., Brodsky, M. C., & Saunte, J. P. (2015). Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children. The British Journal of Ophthalmology, 99(10), 1401-4. https://doi.org/10.1136/bjophthalmol-2015-306855
Correll MH, et al. Lyme Neuroborreliosis: a Treatable Cause of Acute Ocular Motor Disturbances in Children. Br J Ophthalmol. 2015;99(10):1401-4. PubMed PMID: 25868792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children. AU - Correll,M H, AU - Datta,N, AU - Arvidsson,H S S, AU - Melsom,H A, AU - Thielberg,A K, AU - Bjerager,M, AU - Brodsky,M C, AU - Saunte,J P, Y1 - 2015/04/13/ PY - 2015/03/11/received PY - 2015/03/20/accepted PY - 2015/4/15/entrez PY - 2015/4/15/pubmed PY - 2015/12/19/medline KW - Child health (paediatrics) KW - Infection KW - Muscles KW - Pupil SP - 1401 EP - 4 JF - The British journal of ophthalmology JO - Br J Ophthalmol VL - 99 IS - 10 N2 - BACKGROUND: Lyme neuroborreliosis (LNB) designates central nervous system involvement caused by the tick-borne spirochaete Borrelia burgdorferi (Bb). The present study describes a spectrum of acquired ocular motor disorders in children with LNB. METHODS: Six paediatric patients (age 3-15 years) with ocular motor symptoms as first manifestations of LNB evaluated by a paediatrician and ophthalmologist are presented. Diagnosis was based on new onset ocular motor disturbances and detection of cerebrospinal fluid (CSF) pleocytosis and intrathecal synthesis of Bb IgM and/or IgG antibodies by lumbar puncture. The children were evaluated before and after antibiotic treatment with a follow-up time of 1-7 months. Videos were obtained both pre and post treatment in four patients. RESULTS: Two children presented with acquired nystagmus, one with combined nystagmus and partial sixth nerve palsy, one with partial sixth nerve palsy, one with ptosis and one with Adie's pupil. Five of the patients presented with severe fatigue, malaise, nausea, headache and fever. Four had recognised a tick bite recently, and two developed erythema migrans. Intrathecal synthesis of IgM and/or IgG antibodies specific for Bb was positive in all children, and five showed CSF pleocytosis. Cerebral MRI or CT of the brain were normal. Treatment with intravenous or oral antibiotics produced rapid clinical improvement in five of the six children. CONCLUSIONS: LNB can present as acute ocular motor disorders in conjunction with fatigue and other clinical manifestations. In endemic areas, children with unexplained, acquired ocular motor abnormalities should be evaluated for LNB, a treatable medical condition. SN - 1468-2079 UR - https://www.unboundmedicine.com/medline/citation/25868792/Lyme_neuroborreliosis:_a_treatable_cause_of_acute_ocular_motor_disturbances_in_children_ L2 - http://bjo.bmj.com/cgi/pmidlookup?view=long&pmid=25868792 DB - PRIME DP - Unbound Medicine ER -