RESUMO
This is a case report of a 48-year-old female with no medical conditions, with a one-day history of diplopia, mild headache, vertigo and generalized paraesthesia. The neurological examination revealed ophthalmoplegia, ataxia and areflexia leading to a diagnosis of Miller Fisher syndrome, a rare variant of Guillain-Barré syndrome. This highlights the importance of considering the rarer variants of Guillain-Barré syndrome in the differential diagnosis of patients who present with this triad.
Assuntos
Síndrome de Guillain-Barré , Síndrome de Miller Fisher , Oftalmoplegia , Diagnóstico Diferencial , Feminino , Síndrome de Guillain-Barré/diagnóstico , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Pessoa de Meia-Idade , Síndrome de Miller Fisher/complicações , Síndrome de Miller Fisher/diagnóstico , Síndrome de Miller Fisher/terapia , Oftalmoplegia/diagnóstico , Oftalmoplegia/etiologiaRESUMO
In Europe, Lyme neuroborreliosis (LNB) is the most severe manifestation of Lyme borreliosis and has recently been added to the communicable disease surveillance list for EU/EEA by the European Commission. In Northern Europe, LNB is primarily caused by the spirochete Borrelia garinii and transmitted by the tick Ixodes ricinus. This Danish observational epidemiologic case-control study includes every identified LNB patient (n = 401) on Funen, Denmark, from 1995-2014. We display spatial and temporal LNB incidence variation, seasonal distribution of cases and local spatial case clustering. Seasonal patterns show LNB symptom-onset peaking in July and a significant seasonal difference in number of cases (p < 0.01). We found no significant change in seasonality patterns over time when dividing the study period into 5-year intervals. We identified a significant local geographical hot-spot of cases with a relative risk of 2.44 (p = 0.013). Analysis revealed a significantly shorter distance to nearest forest for cases compared with controls (p < 0.001). We present a novel map of the focal geographical distribution of LNB cases in a high endemic borreliosis area. Continued studies of case clustering in the epidemiology of LNB are of key importance in guiding intervention strategies.