Complex regional pain syndrome and lyme borreliosis: two different diseases?

Complex regional pain syndrome (CRPS) is a frequent complication appearing as pain of unexplained pathogenesis. Its association with Lyme borreliosis (LB) is fairly rare. In the presented clinical case, clinical features as well as the findings of radiological, radionuclide, neurophysiological and serological investigations pointed to an association between the two conditions. The patient fulfilled the criteria for both diagnoses, i.e. CRPS and LB. The subsequent antibiotic therapy resulted in a complete remission of both clinical entities.

Autonomic system dysfunction in moderate diabetic polyneuropathy assessed by sympathetic skin response and Valsalva index.

30 patients with moderate diabetic polyneuropathy (Stage 2 according to Dyck) were evaluated for autonomic symptoms, sympathetic skin response (SSR) and Valsalva index. Their SSR were compared to a control group of 30 healthy normal subjects. Neuropathy was confirmed by history, clinical examination and nerve conduction measurements. Although our patients had only moderate polyneuropathy autonomic dysfunction was frequent. Two thirds reported autonomic symptoms. Impotence was present in 60% of males. SSR amplitudes were significantly lower in diabetics (changed in 53%, absent in 20%) than in the controls. SSR abnormality correlated to some clinical and electroneurographic signs of neuropathy, suggesting similar affection of sympathetic and somatic fibres. Valsalva index was abnormal in 37% of patients showing no correlation to clinical, electroneurographic or SSR changes.