Abstracts

Rationale: Lyme neuroborreliosis (LNB) is an infectious disorder of the nervous system caused by species of the spirochete Borrelia burgdorferi (Bb).Clinical features of LNB differ in European and American patients – most probably because of different bacteria species. LNB in the USA usually presents as a lymphocytic meningitis. Meningopolyradiculitis is the most common manifestation in Europe. 75% of LNB children in Europe present symptoms of mild aseptic meningitis and/or 69% peripheral facial nerve palsy. Epileptic seizures in the course of LNB are reported casuistically Methods: Case report: 9 years old girl without epilepsy in anamnesis was admitted with right side Tod’s paresis after partial sensor epileptic seizure with secondary generalizing. Seizure started with pain in right ben and next in right arm and very quickly evolved to generalized tonic-clonic seizures. Clinical and neuroimaging follow up was made Results: Neurological examination at admission– consciousness preserved, right side Tod’s paresis, normal cranial nerves examination. After 2 days, any abnormalities in neurological examination. MRI without gadolinium showed in the left fronto-parietal region increased T2 signal with restriction in diffusion sequences suggesting vascular character of changing. Patient was discharged from hospital with acetylsalic acid treatment. After 4 weeks was admitted again with decreased feeling in the right hand and next with reduced muscle strength in the right lower and upper limb. Consciousness not disturbed. MRI with gadolinium showed increased T2 signal subcortical in fronto-parietal region(Fig2) with leptomeningeal enhancement(Fig3). Lumbar puncture revealed pleocytosis (64 cells/?l with 63 mononuclear cells). Serological studies for Bb in cerebrospinal fluid were positive for IgM and IgG antibodies. Treatment with intravenous ceftriaxone was initiated. The patient had no further seizures or neurological symptoms. Cranial MRI four months later was normal. Conclusions: Epileptic seizures as symptom of early LNB in children are not common while epileptic seizures as initial symptom of LNB are reported casuistically.Vasculitis is reported as a primary pathophysiological mechanism for focal cerebral lesions and leptomeningeal contrast enhancement in LNB. Funding: none