Subscribe to RSS
DOI: 10.1055/s-0030-1248440
© Georg Thieme Verlag KG Stuttgart · New York
Guillain-Barré-Syndrom nach Neuroborreliose? Ähnliches Syndrom, andere Erkrankung
Guillain-Barré Syndrome after Neuroborreliosis? Similar Syndrome, Different DiseasePublication History
Publication Date:
11 May 2010 (online)
![](https://www.thieme-connect.de/media/aktneu/201004/lookinside/thumbnails/10.1055-s-0030-1248440-1.jpg)
Zusammenfassung
Die Differenzialdiagnose des akuten polyradikulären Syndroms schließt eine Lyme-Neuroborreliose im Stadium II ein. Die Bestätigung dieser Diagnose erfordert neben dem Nachweis eines entzündlichen Liquorsyndroms, eine intrathekale, borrelienspezifische Antikörperproduktion. Vorgestellt wird eine Patientin mit einer Neuroborreliose Stadium II, die diese Kriterien erfüllte und auf eine Antibiotikatherapie mit Ceftriaxion klinisch und liquorchemisch gut ansprach. Die Entwicklung einer hochgradigen peripheren Tetraparese mit den elektrophysiologischen Befunden einer Polyradikulitis nach einem viralen Infekt führte zur Diagnose eines Guillain-Barré-Syndroms. Die Schwierigkeiten in der Diagnosestellung einer 2. Erkrankung mit ähnlichem klinischem Syndrom aber unterschiedlicher Pathogenese, werden diskutiert.
Abstract
The differential diagnosis of the acute polyradiculopathic syndrome includes Lyme neuroborreliosis stage II. The confirmation of this diagnosis requires, in addition to the detection of an inflammatory process in the cerebrospinal fluid, evidence of an intrathecal Borrelia-specific antibody production. Here, we report on a patient with Lyme neuroborreliosis stage II, who met these criteria and responded well to antibiotic therapy with ceftriaxone. Development of a peripheral tetraparesis with the electrophysiological findings of a polyradiculitis after viral infection led to the diagnosis Guillain-Barré syndrome. The difficulties in making the diagnosis of a second disease with a similar clinical syndrome but different pathogenesis, are discussed.
Schlüsselwörter
Guillain-Barré-Syndrom - Polyradikulitis - Neuroborreliose
Keywords
Guillain-Barré syndrome - polyradiculitis - neuroborreliosis
Literatur
- 1 Halperin J J, Logigian E L, Finkel M F. et al . Practice parameters for the diagnosis of patients with nervous system lyme borreliosis (Lyme disease). Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1996; 46 619-627
- 2 Kaiser R, Rauer S. Analysis of the intrathecal immune response in neuroborreliosis to a sonicate antigen and three recombinant antigens of Borrelia burgdorferi sensu stricto. Eur J Clin Microbiol Infect Dis. 1998; 17 159-166
- 3 Wormser G P, Dattwyler R J, Shapiro E D. et al . The clinical assessment, treatment and prevention of lyme disease, human granulocytic anaplasmosis, and babeosis: clinical practice guidelines by the Infectious Diseases Societies of America. Clin Infect Dis. 2006; 43 1089-1134
- 4 Rupprecht T A, Koedel U, Fingerle V. et al . The pathogenesis of lyme neuroborreliosis: from infection to inflammation. Mol Med. 2008; 14 205-212
- 5 Seta T, Nagayama H, Katsura K. et al . Factors influencing outcome in Guillain-Barré syndrome: comparison of plasma adsorption against other treatments. Clin Neurol Neurosurg. 2005; 107 491-496
- 6 Rupprecht T A, Birnbaum T, Pfister H W. Pain and neuroborreliosis: significance, diagnosis and treatment. Schmerz. 2008; 22 615-623
- 7 Kindstrand E, Nilsson B Y, Hofmark A. et al . Polyneuropathy in late lyme borreliosis – a clinical, neurophysiological and morphological desription. Acta Neurol Scand. 2000; 101 47-52
- 8 Rupprecht T A, Elstner M, Weil S. et al . Autoimmune-mediated polyneuropathy triggered by borrelial infection?. Muscle Nerv. 2008; 37 781-785
- 9 Hughes R. The role of IVIg in autoimmune neuropathies: the latest evidence. J Neurol. 2008; 255 7-11
Dr. Peter Dirk Albrecht
EVK Wesel, Neurologie
Schermbecker Landstr. 88
46485 Wesel
Email: palbrecht@evkwesel.de