PÄÄNSÄRKY BORRELIOOSISSA

[Bb]

Lähettäjä: Soijuv Lähetetty: 18.11.2005 11:18

Norjalaiset tutkijat esittävät 2 tapausselostusta joissa neuroborrelioosia sairastavien henkilöiden pääasiallinen oire oli päänsärky. Päänsärky kehittyi muutaman päivän sisällä ja kesti toisella 3 kk ja toisella 2 1/2 vuotta ennenkuin diagnoosiin päädyttiin.


Cephalgia: Headache resembling tension-type headache as the single
manifestation of Lyme neuroborrelosis Thomas, Klaus Hansen, Jes Olesen
1993;13;207-9. Oslo iISSN O333-1024

"We present two patients with monosymptomatic headache resembling chronic tension-type as the first manifestation of Lyme neuroborreliosis. The headache developed over a few days in both cases and lasted for three months in the first case and for two and a half years in the second case before the diagnosis fo Lyme neuroborreliosis was made.

Neuroimaging and many laboratory investigations did not lead to the diagnosis, which was only established after lumbar puncture. The CFS in both cases showed high protein, lymphocytic pleocytosis and Borrelia burgdorferi-specific intraethical antibody synthesis.

This headache disappeared completely after treatment with penicillin G. (this observation does not mean that the disease is gone ). "In patients suffering from daily headaches which have developed subacutely, Lyme neuroborreliosis should be considered even in the absence of signs of meningeal irritation. A lumbar puncture should be performed more often than a presently customary and the CSF should be examined for pleocytosis as well as Borrelia burgdorferi-specific intrathecal antibody synthesis.

".......In the cases presented...the patients complained of a headache of relatively long duration and this complaint brought them to the physician.
At the time of admission virtually no other symptoms could be found in spite of several thorough clinical investigations..........

"Discussion-- ....

1. None of the patients had meningeal signs or fever in spite of an ongoing neuroinfection, which is typical for Lyme neuroborreliosis. (2,3,4)

2. Though both cases bear some resemblence to chronic tension-type headaches, neither of them actually fulfilled the criteria for chronic tension-type headache according to the classification and diagnostic criteria for headache disorders of the International Headache Society (10). In the first case the duration of the headache from the start of the symptoms to the diagnosis made was too short. In the second case criteria for tension-type headache were not fulfilled because of the extensor plantar response at some of the neurological examinations.

Furthermore, in the first case the fact that the patient was vomitingng regularly and also the presence of nausea and photophobia excludes the diagnosis of chronic tension-type headache according to the IHS classification (10) . The worsening of pain by physical activity also speaks against tension-type headache. The headaches thus did not fulfill the IHS criteria of chronic tension-type headache.

3. Both patients,over a few days, and, for no apparent reason, changed from having almost no headache to having constant daily headache . This headache continued and increased slowly over several weeks. Such onset of chronic tension-type headache is infrequent, but by no means unknown. Usually, however, chronic tension-type headache develops over several years, frequently being the result of a transformation form episodic tension-type headache or migraine (8,9).

4. When the responsible neurologist recognized that these patients did not have tension-type headache they oprdered neuroimaging, and only after a considerable delay was this supplemented by a lumber puncture.

"Our patients show that headache can be the first, and for a long time the
only, prominent sign of Lyme neuroborreliosis. In evaluating patients with headaches, one should therefore be specifically catious when the headaches do not fulfil the IHS criteria completely. Patients with chronic headache should be investigated vigorously if the onset is subacute and always is such cases a lumbar puncture should be obtained. Lumbar puncture is often delayed in patients with Lyme neruoborrleiosis because they only rarely exhibit meningeal signs . The findings of lymphocytic pleocytosis in CSF shoulod lead to the examination for B. burgdorferi-specific antibodies in serum and especially in CSF. (7). However, the serological tests for Lyme disease are not always reliable and include both false positive and false negative results. If appropriate, a therapeutic trial of antibiotic may be included."