Rev Neurol France
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The neurological spectrum of Borrelia burgdorferi infections is still enlarging. We review epidemiological, pathological and serological data of Lyme disease. The course of the disease is divided in three stages: stage 1 during the first month is characterised by erythema chronicum migrans and associated manifestations; stage 2 includes not only the classical European meningoradiculitis but also less specific neurological symptoms: isolated lymphocytic meningitis with an acute or even relapsing course, apparently idiopathic facial palsy, neuritis of other cranial nerves, polyneuritis cranialis, Argyll-Robertson sign, peripheral nerve involvement, acute transverse myelitis, severe encephalitis, myositis. ⋯ High doses of penicillin can halt the disease, sometimes induce spectacular regression of symptoms or sometimes be inefficient; ceftriaxone could be a more powerful therapy. Similarities between syphilis and Borreliosis are multiple: both of these spirochetes contain plasmids, can be transmitted through the placenta and progress for many years through successive stages, with multiorgan symptoms, including parenchymatous and vascular lesions of the central nervous system. Borrelia burgdorferi is the new great imitator.
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Fifteen cases of perineal neuralgia are reviewed, the lesion arising from a canal syndrome due to compression of the pudendal nerve in the ischiorectal fossa (Alcock's canal syndrome). The clinical characteristic of the pain syndrome was its postural nature with the existence of a true Tinel sign (increased pain on sitting). ⋯ Treatment was infiltration of cortisone derivatives into the pudendal nerve canal, under CT guidance because of the difficulty of infiltrating the pudendal nerve by an external perineal approach. Results were satisfactory in 9 of the 15 patients.
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Idiopathic acute orbital myositis is a subgroup of inflammatory orbital pseudotumor. The case of a 35 year-old woman who suffered a left ocular pain with eyelid swelling, conjunctival hyperemia and limitation of abduction of the left eye is reported. ⋯ The pathogenesis remained obscure. The evolution was favourable with corticosteroids.