Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children

Correll, Mette; Datta, Nigel; Arvidsson, H S S; Melsom, H; Thielberg, A K; Bjerager, Mia Ortved; Brodsky, Michael C.; Saunte, Jon Peiter

doi:10.1136/bjophthalmol-2015-306855

Cited by 14 publications

(6 citation statements)

References 22 publications

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“…Some of the ocular complications reported include conjunctivitis, dacryoadenitis, episcleritis, keratitis, iritis, and optic neuritis in herpetic viral infections 27,28 . Ophthalmoplegia and cranial nerve palsies, abnormal ocular movements, nystagmus, anisocoria, ptosis, jerky movements, and oscillopsia have also documented an association with encephalitis [29][30][31][32] . However, there is a scarcity of studies that describe ophthalmological findings in a pediatric population with non-traumatic coma.The few ophthalmologic findings in this study did not significantly influence the management of our patients.…”

Section: Resultsmentioning

confidence: 99%

Ophthalmological Findings in Paediatric Non-Traumatic Coma in Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria

et al. 2020

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The ophthalmological examination is a vital aspect of the central nervous system examination in comatose children. Several authors have documented different findings with disparities in their recommendations about making ophthalmological examination a routine in the management of the unconscious child. This study sought to evaluate the relevance of routine ophthalmological examination in the management of unconscious children admitted into the paediatric emergency room of Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria. This was a prospective longitudinal study conducted from April 2018 to March 2019. Unconscious patients whose caregivers gave consent were recruited into the study. Traumatic causes of coma were excluded. Demographic features of the patients were obtained. The ophthalmologic examination and diagnoses were made by an ophthalmologist, while the emergency room pediatrician made clinical assessment and diagnoses. Sixteen unconscious children had ophthalmologic examinations done. The Glasgow coma scale scores ranged from 3 to 11, with a mean of 6.6±2.2. Thirteen (81.3%) of the children were classified as severe unconsciousness while the rest were moderate. The degree of unconsciousness was significantly associated with the outcome (χ2 =16.0, P = 0.03). A total of six (37.5%) ophthalmologic diagnoses were made, which included cerebral malaria, degenerative myopia, orbital cellulitis, and exposure keratopathy. The presence of an abnormal ophthalmologic finding was not significantly associated with outcome (χ2 =0.36, P = 0.55). Routine ophthalmologic examination may not be justified as a management protocol in unconscious children but may be considered in selected cases.

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Section: Resultsmentioning

confidence: 99%

Ophthalmological Findings in Paediatric Non-Traumatic Coma in Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria

et al. 2020

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“…Moreover, four of the six had noted a tick bite and two had noticed EM (Correll et al. ). When looking at the children in our study, two children, both aged 8, recalled having been bitten but had not noticed EM.…”

Section: Discussionmentioning

confidence: 99%

Ophthalmological findings in neuroborreliosis – a prospective study performed in western Sweden

Škiljić

Gustavsson

Dotevall

et al. 2018

Acta Ophthalmologica

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The majority of patients diagnosed with neuroborreliosis had ophthalmological symptoms and/or findings. Facial palsy with palpebral diastasis was a common finding. Onset of diplopia and/or sixth nerve affection may be a first sign of neuroborreliosis. Number of ophthalmological findings was correlated with the CSF antibody titre. Ticks are becoming more widespread and abundant, resulting in a higher incidence of neuroborreliosis. Hence, the knowledge of ophthalmological symptoms and findings is of great importance.

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“…CSF markers -including CSF-CXCL13 -have also been suggested as helpful in the diagnostic work-up for Lyme disease (21) . Computed tomography and magnetic resonance imaging findings show no abnormalities (7) . Neuroborreliosis should be suspected in all children with headache growing in intensity for more than 7 days, peripheral facial nerve palsy, and the proportion of mononuclear cells in the CSF assessment exceeding 70% (so-called "rule of sevens") (22) .…”

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confidence: 94%

“…In children, the clinical picture of neuroborreliosis tends to vary widely. Neuroborreliosis has been reported to be accompanied by damage to other cranial nerves, often involving the motor nerves of the eyeball and the optic nerve (6)(7)(8)(9) . Other reports have included acute, frequently transient ischaemic central nervous system disorders as well as acute cerebellar symptoms, and isolated intracranial hypertension (10)(11)(12) .…”

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confidence: 99%

Peripheral facial nerve palsy as a manifestation of neuroborreliosis in children

Zielińska¹,

Zieliński²

2019

PEDIATR MED RODZ

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Lyme disease, also known as Lyme borreliosis, is a systemic infectious disease caused by Borrelia burgdorferi spirochetes. It is spread by the bites of infected ticks of the genus Ixodes which inhabit forest plants in the northern hemisphere, including western Asia and Europe. In the classic course of Lyme disease, the most common early manifestations include erythema migrans, a circular red skin rash around the tick bite, and general symptoms. The most prevalent clinical manifestation of late disease is neuroborreliosis. The migration of urban residents to regions endemic to ticks of the genus Ixodes which are vectors of Borrelia burgdorferi increases the risk of neuroborreliosis in all children regardless of their place of residence, especially during the summer and early autumn. The absence of characteristic manifestations in the first stage of the disease, shortly after the tick bite, involving typical skin lesions and systemic symptoms, may result in delayed diagnosis and initiation of causal treatment. In adult patients, the disease appears typically as meningoradiculoneuritis. In children, common manifestations associated with late-stage Lyme disease are meningitis and cranial nerve palsy including peripheral facial nerve palsy. Symptoms of neuroborreliosis are uncommon in the early stage of the disease. Facial nerve palsy can be a diagnostic symptom of multiple nervous system disorders, including infectious diseases. Neuroborreliosis is a form of Lyme disease that affects the structures of the nervous system, and may present as peripheral facial nerve palsy. Consequently, children with peripheral facial nerve palsy should undergo diagnostic work-up for Borrelia burgdorferi infection also in cases without typical erythema migrans in the early stage of the disease.

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Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children

Abstract: 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.

Cited by 14 publications

References 22 publications

Ophthalmological Findings in Paediatric Non-Traumatic Coma in Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria

Ophthalmological Findings in Paediatric Non-Traumatic Coma in Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria

Ophthalmological findings in neuroborreliosis – a prospective study performed in western Sweden

Peripheral facial nerve palsy as a manifestation of neuroborreliosis in children

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