Bannwarth syndrome
The Bannwarth syndrome is a rare sub-form of neuroborreliosis caused by Borrelia burgdorferi . The symptom complex consists of the triad of painful myelo radiculitis (inflammation of the roots of the spinal nerves ), lymphocytic meningitis and failure of cranial nerves , particularly often facial paralysis .
Initial description
The Munich neurologist Alfred Bannwarth (1903–1970) was long regarded as the first person to describe the clinical syndrome. He interpreted it as “lymphocytic meningoradiculitis” due to the inflammatory reactions in the cerebrospinal fluid (“nerve fluid ”). Only years after his death was the clearly bacterial genesis recognized and the Bannwarth syndrome recognized as a special form of borreliosis or Lyme disease.
Many years before Bannwarth, the French Garin and Boujadoux had described similar cases in 1922, which is why the syndrome is also known as Garin-Boujadoux-Bannwarth syndrome in French. It is now considered a clinical manifestation of the secondary stage of Lyme disease .
Symptoms
Meningoradiculitis is a subacute disease in which symptoms develop over weeks. In addition to the typical symptoms, especially with radicular pain and muscle weakness, spinal paresthesias , sleep disorders , headaches and exhaustion are often found. In addition, half of the patients develop erythema migrans in the course of the disease , which is groundbreaking for the diagnosis of Lyme borreliosis. Almost all patients have radicular pain, which typically affects several neighboring nerve roots and is in the area of the existing or previous erythema.
In addition to frequent facial paralysis, failure of the trigeminal nerve with hypoesthesia in the facial area is the second most common form of cranial nerve failure.
Gastrointestinal disorders, especially abdominal pain and constipation, are much less common . Flaccid and ascending paralysis have also been described.
Diagnosis
In the spinal tap there are increased lymphocytes ( "Lymphocytic pleocytosis ") with increased protein levels in normal glucose level.
The diagnosis is made by detection of the pathogen via ELISA and confirmation via Western blot . More recent developments attempt to detect antibodies against the surface protein C6, which is already more sensitive in the first month .
therapy
Meningo radiculitis is very treatable, and if the symptoms are typical, treatment should be started before the pathogen is detected. In 95% of the patients there is an improvement in symptoms with antibiotic therapy for 10 to 28 days . In a large review article , parenteral penicillin, ceftriaxone , cefotaxime and doxycycline were described as effective antibiotics. Oral doxycycline and parenteral beta-lactams are considered equivalent.
Web links
Individual evidence
- ↑ Christopher Iriarte, Henrikas Vaitkevicius, Francisco M. Marty, Amy L. Miller, Joseph Loscalzo: Missing the Target . New England Journal of Medicine 2020, Volume 382, Issue 14 April 2, 2020, Pages 1353-1359, DOI: 10.1056 / NEJMcps1901669
- ↑ C. Garin, A. Boujadoux: Paralysie par les tiques. In: J Med Lyon. 1922; 71, pp. 765-767
- ↑ JJ Halperin, ED Shapiro, E. Logigian, AL Belman, L. Dotevall, GP Wormser, L. Krupp, G. Gronseth, CT Bever Jr. for the "Quality Standards Subcommittee of the American Academy of Neurology": Practice parameters: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology 2007, Volume 69, Issue 1 of July 3, 2007, pages 91-102, DOI: 10.1212 / 01 .wnl.0000265517.66976.28