Biomaterial Database

Isolated trochlear palsy secondary to Lyme neuroborreliosis. 2011

Simon R Bababeygy, and Peter A Quiros

Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, 1450 San Pablo Street, DVRC 311, Los Angeles, CA 90033, USA.

The objective of the study is to report the first case of isolated trochlear palsy secondary to Lyme neuroborreliosis in an adult. A 22-year-old male presented with history of flu-like illness and headache, accompanied by vertical binocular diplopia, worse on downgaze and better in upgaze and right head tilt. Physical examination revealed trochlear palsy on the left side with a compensatory head tilt to the opposite side. A subsequent workup for trochlear palsy was conducted, including hematological and cerebral spinal fluid serum studies, and magnetic resonance imaging of the brain. Immunoglobulin (Ig)M and IgG antibodies against Borrelia burgdorferi were positive in serum and cerebral spinal fluid (CSF). Symptoms of double vision completely resolved after 3 weeks of antibiotic treatment with intravenous ceftriaxone. CSF studies, in addition to clinical symptoms of vertical double vision and a positive Parks 3-step test, are a good diagnostic tool for B. burgdorferi. Resolution of symptoms was noted after a complete course of intravenous ceftriaxone.

UI	MeSH Term	Description	Entries
D007074	Immunoglobulin G	The major immunoglobulin isotype class in normal human serum. There are several isotype subclasses of IgG, for example, IgG1, IgG2A, and IgG2B.	Gamma Globulin, 7S,IgG,IgG Antibody,Allerglobuline,IgG(T),IgG1,IgG2,IgG2A,IgG2B,IgG3,IgG4,Immunoglobulin GT,Polyglobin,7S Gamma Globulin,Antibody, IgG,GT, Immunoglobulin
D007075	Immunoglobulin M	A class of immunoglobulin bearing mu chains (IMMUNOGLOBULIN MU-CHAINS). IgM can fix COMPLEMENT. The name comes from its high molecular weight and originally was called a macroglobulin.	Gamma Globulin, 19S,IgM,IgM Antibody,IgM1,IgM2,19S Gamma Globulin,Antibody, IgM
D008297	Male		Males
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000907	Antibodies, Bacterial	Immunoglobulins produced in a response to BACTERIAL ANTIGENS.	Bacterial Antibodies
D055815	Young Adult	A person between 19 and 24 years of age.	Adult, Young,Adults, Young,Young Adults
D020432	Trochlear Nerve Diseases	Diseases of the fourth cranial (trochlear) nerve or its nucleus in the midbrain. The nerve crosses as it exits the midbrain dorsally and may be injured along its course through the intracranial space, cavernous sinus, superior orbital fissure, or orbit. Clinical manifestations include weakness of the superior oblique muscle which causes vertical DIPLOPIA that is maximal when the affected eye is adducted and directed inferiorly. Head tilt may be seen as a compensatory mechanism for diplopia and rotation of the visual axis. Common etiologies include CRANIOCEREBRAL TRAUMA and INFRATENTORIAL NEOPLASMS.	Cranial Nerve IV Diseases,Fourth Cranial Nerve Diseases,Fourth Cranial Nerve Palsy,Fourth Nerve Palsy,Neurogenic Superior Oblique Palsy,Superior Oblique Myokymia,Superior Oblique Palsy, Neurogenic,Trochlear Nerve Disorders,Trochlear Nerve Palsy,Trochlear Neuropathy,Fourth Nerve Palsies,Myokymia, Superior Oblique,Myokymias, Superior Oblique,Neuropathies, Trochlear,Neuropathy, Trochlear,Palsies, Fourth Nerve,Palsies, Trochlear Nerve,Palsy, Fourth Nerve,Palsy, Trochlear Nerve,Superior Oblique Myokymias,Trochlear Nerve Disease,Trochlear Nerve Disorder,Trochlear Nerve Palsies,Trochlear Neuropathies
D020852	Lyme Neuroborreliosis	Nervous system infections caused by tick-borne spirochetes of the BORRELIA BURGDORFERI GROUP. The disease may affect elements of the central or peripheral nervous system in isolation or in combination. Common clinical manifestations include a lymphocytic meningitis, cranial neuropathy (most often a facial neuropathy), POLYRADICULOPATHY, and a mild loss of memory and other cognitive functions. Less often more extensive inflammation involving the central nervous system (encephalomyelitis) may occur. In the peripheral nervous system, B. burgdorferi infection is associated with mononeuritis multiplex and polyradiculoneuritis. (From J Neurol Sci 1998 Jan 8;153(2):182-91)	Central Nervous System Lyme Disease,Nervous System Lyme Borreliosis,Neuroborreliosis, Borrelia burgdorferi,Peripheral Nervous System Lyme Disease,Encephalopathy, Lyme Disease,Lyme Borreliosis, Nervous System,Lyme Disease Encephalopathy,Lyme Disease Mononeuritis Multiplex,Lyme Disease, Central Nervous System,Lyme Disease, Nervous System,Lyme Meningoencephalitis,Lyme Meningoradiculitis,Lyme Polyradiculitis,Lyme Polyradiculopathy,Meningoencephalitis, Lyme,Mononeuritis Multiplex, Lyme Disease,Nervous System Lyme Disease,Borrelia burgdorferi Neuroborreliosis,Encephalopathies, Lyme Disease,Lyme Disease Encephalopathies,Lyme Polyradiculitides,Lyme Polyradiculopathies,Meningoradiculitis, Lyme,Neuroborrelioses, Borrelia burgdorferi,Neuroborreliosis, Lyme,Polyradiculitides, Lyme,Polyradiculitis, Lyme,Polyradiculopathies, Lyme,Polyradiculopathy, Lyme
D025065	Borrelia burgdorferi	A specific species of bacteria, part of the BORRELIA BURGDORFERI GROUP, whose common name is Lyme disease spirochete.	Borrelia burgdorferi sensu stricto,Lyme Disease Spirochete