Topic: Case Report: Woman with vertigo turns out to have lyme disease, and hearing loss
Vermont_Lymie
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Here is an interesting case report, from the Italian journal Neurological Sciences.
A 29-year old woman has vertigo and so gets medical tests; turns out she has lyme disease, and also hearing loss on the left side.
The authors note that she did not realize that she had hearing loss.
Unfortunately, she is treated with only 2 weeks of rocephin and the authors found this did not cure her symptoms!
Don't these Italian neurologists read Dr. B's guidelines? Let's hope this woman finds lymenet Europe or USA.
Below, the first page of the article and a paragraph on her treatment from page 3 is reprinted:
******************* Case Report
Neurol Sci (2004) 25:30-33
Isolated monolateral neurosensory hearing loss as a rare sign of neuroborreliosis
I. Iero *M. Elia *F.I.I. Cosentino *B. Lanuzza *R.S. Spada *G. Toscano *M. Tripodi *A. Belfiore *R. Ferri
Corresponding author: I. Iero, Department of Neurology Oasi Institute for Research on Mental Retardation and Brain Aging Via Conte Ruggero 73, I-94018 Troina (EN), Italy e-mail: [email protected]
Received: 6 June 2003 / Accepted in revised form: 26 January 2004
Abstract
Lyme disease, or borreliosis, is a zoonosis transmitted by Borrelia burgdorferi which also involves the central nervous system (CNS), in 15% of affected individuals, with the occurrence of aseptic meningitis, fluctuating meningoencephalitis, or neuropathy of cranial and peripheral nerves.
Encephalopathy with white matter lesions revealed by magnetic resonance imaging (MRI) scans in late, persistent stages of Lyme disease has been described.
In this report, we describe a patient with few clinical manifestations involving exclusively the eighth cranial nerve, monolaterally and diffuse bilateral alterations of the white matter, particularly in the subcortical periventricular regions at cerebral MRI.
This single patient study shows that the search for antibodies against Borrelia burgdoferi should always be performed when we face a leukoencephalopathy of unknown origin.
An isolated lesion of the eighth cranial nerve can be the only neurologic sign in patients with leukoencephalopathy complicating Lyme disease.
Introduction
Lyme disease, or borreliosis, is a zoonosis transmitted by Borrelia burgdorferi (carried by the tick Ixodes ricinusin Europe). The disease was first reported in the town of Lyme (Connecticut, USA) in 1977.
In Italy, Lyme disease occurs mainly in coastal areas of Liguria, in Friuli Venezia Giulia, and in the region surrounding the city of Bologna.
In its clinical course, Lyme disease involves skin, heart, joints and, in 15% of affected individuals, central nervous system (CNS) [1].
Sometimes, CNS is already involved at the onset of the clinical manifestations of Lyme disease; however, most often the CNS is involved only months after onset, and the disorders appear as aseptic meningitis or fluctuating meningoencephalitis, and neuropathy of cranial nerves most often involved) and of peripheral nerves.
The literature describes cases with seizures, choreiform movements, cerebellar ataxia, dementia and myelitic syndrome.
Encephalopathy with white matter lesions revealed at magnetic resonance imaging (MRI) in late, persistent stages of Lyme disease has been described [1].
In this report, we describe a patient with few clinical manifesta- tions involving exclusively the eighth cranial nerve, monolaterally.
Case report
The patient, a 29-year-old woman who was born and still living in the Province of Siracusa, had subcontinous mixed vertigo with recurrent exacerbations.
For this reason, she had undergone several instrumental and laboratory tests.
Among these, cerebral computed tomography (CT) revealed diffuse, hypodense periventricular white matter which was confirmed by cerebral MRI that showed the presence of foci of hyperintense signal in white matter on T2-weighted images.
Because of these findings, a diagnosis of possibile multiple sclerosis was made and the patient was referred to us.
Her clinical history was uneventful except for contacts with a dog until three years earlier. The clinical neurological examination only revealed the presence of diffuse hyperexcitable tendon reflexes and bilateral Babinski's sign.
Page three:
``examination and tonal audiometry tests showed complete neurosensory hearing loss on the left and normal hearing on the right. Brain stem auditory evoked potentials, imped- ance audiometry and otostapedial reflex tests were consistent with neurosensory hearing loss on the left side.
Currently, the patient continues to experience vertigo, which is under treatment with betahistine (24 mg/day) with scarce benefit.
There is no agreement in the literature on the efficacy of drug administration in the chronic phase of neuroborrelliosis: some authors suggested the use of antibiotics [3, 5], others reported no effects of these agents [7].
We treated this patient with ceftriaxone (2 g/day, for 15 days) without any detectable effect; also betahistine was not effective, which we used as a symptomatic treatment of vertigo, probably because of the important involvement of the eighth cranial nerve.
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Vermont_Lymie
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Another thing that is interesting about this case report -
Is that doctors in Italy have no problem recognizing that late-stage lyme is a chronic infection, and that is what they call it in this article.
But, they do not know how to treat it! Is it really such an incomprehensible idea to think that an on-going infection may need on-going long-term treatment?
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You are right. How hard is it to think that more treatment was needed?
I never believe these case reports that talk about one symptom or another being rare. Don't see how anyone knows the true incidence of something like hearing loss in lyme because it is so often misdiagnosed.
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shazdancer
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Way back in 1980, Steere and Logigian reported on their follow-ups with 27 of their early patients. Four of them (15%) had hearing loss.
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