[Acute myelitis and Lyme disease].
BACKGROUND
Acute myelitis accounts for 4 to 5 percent of all cases of neuroborreliosis. In the literature, simultaneous spinal MRI and cerebrospinal fluid (CSF) investigations are presented for only 8 cases. We describe here 3 cases of acute Lyme myelitis.


METHODS
In a cohort of 45 patients with neuroborreliosis, diagnosed between January 1998 and January 2005, 3 had acute myelitis. Clinical, biological and radiological data were studied.


METHODS
The three patients had motor, sensorial and sphincter involvement. Extra-spinal involvement, such as fever and headache for one, facial nerve palsy for the second and subarachnoid hemorrhage for the third, was also noted. Pleocytosis varied from 10 to 520 white cells per mm3. Lyme serology was positive in CSF for all. Intrathecal anti-Borrelia antibody index was positive or intermediate for all three patients. Spinal cord MRI revealed a large hyperintense zone involving more than 3 vertebral segments. Myelitis was central, posterior or transverse in the axial plane. The clinical course was favorable after a three-week course of appropriate antibiotics.


CONCLUSIONS
These 3 cases and the others from the literature show the diversity of the clinical and radiological features of acute myelitis: transverse, central or posterior myelitis. Thus, Lyme serology in CSF in indicated for patients presenting acute myelitis, particularly in endemic areas.
Blanc
F
F
Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg. Frederic.Blanc@chru-strasbourg.fr
Froelich
S
S
Vuillemet
F
F
Carré
S
S
Baldauf
E
E
de Martino
S
S
Jaulhac
B
B
Maitrot
D
D
Tranchant
C
C
de Seze
J
J
D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000032:analysis / Q000134:cerebrospinal fluid; D015153:Blotting, Western; D025065:Borrelia burgdorferi / Q000276:immunology; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007964:Leukocytosis / Q000209:etiology; D008193:Lyme Disease / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009187:Myelitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D009188:Myelitis, Transverse / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial