Archive for the ‘Eye Issues’ Category

Subacute Transverse Myelitis Caused by Borrelia Infection

https://danielcameronmd.com/subacute-transverse-myelitis/

SUBACUTE TRANSVERSE MYELITIS CAUSED BY BORRELIA INFECTION

woman with subacute transverse myelitis getting eye exam

Lyme neuroborreliosis can manifest as encephalitis or acute/subacute transverse myelitis. Only a handful of subacute transverse myelitis cases have been reported in the literature. In their article, “Subacute transverse myelitis with optic symptoms in neuroborreliosis: a case report,” Opielka et al. describe one of the few cases of subacute transverse myelitis (SaTM) associated with Lyme neuroborreliosis and involving the optic nerve.

Subacute transverse myelitis is a neurologic syndrome caused by inflammation of the spinal cord.  It can be caused by various infections, including Borrelia burgdorferi, the bacteria causing Lyme disease. Immune system disorders, vascular and other inflammatory disorders can also trigger the condition which damages or destroys myelin, an insulating substance that surrounds nerves, including those in the brain and spinal cord. ¹

It’s estimated that “transverse myelitis with infectious or parainfectious etiology accounts for 12%” of all cases, writes Opielka. Borrelia burgdorferi is one of the infectious agents known to trigger the disease. But in 40% of the cases, the cause is unknown.

Typical symptoms associated with transverse myelitis include bilateral or unilateral limb weakness, sensory disturbances, and disruption of the autonomic system. Approximately 1 in 3 patients with transverse myelitis report having a febrile illness around the onset of neurologic symptoms.

Diagnostically challenging case

The authors describe the case of a 23-year-old woman, ² who was admitted to the hospital due to hand tremors and paresthesia (burning or prickling sensation) which extended to her forearms. She did not, however, exhibit upper arm weakness.

The woman also had severe pain in the mid-cervical region and for 3 months prior, had suffered from nausea and vertigo.

Lyme neuroborreliosis presents as subacute transverse myelitis. CLICK TO TWEETShe experienced transient periods of double vision when looking at distant objects. And reportedly had a fever which lasted for 2 days several months prior to her hospital admission. She did not recall a tick bite.

“The clinical presentation of our patient was diagnostically challenging,” the authors write.

“The only indicator of a possible tick bite was an episode of raised temperature, followed by symptoms of neck stiffness and pain reported by the patient.” Furthermore, a long period of time elapsed between the onset of symptoms and hospitalization.

Tests indicate elevated intracranial pressure

Tests revealed the patient had bilateral papilloedema (optic disc swelling caused by increased intracranial pressure) and bilateral diffuse thickening of the retinal fiber nerve layer in all quadrants.

“Blurred optic margins and several flame-like peripapillary hemorrhages were observed in both eyes,” as well, writes Opielka.

Based on nerve conduction study findings, “radiculopathy of nerve roots of both peroneal nerves and the right median nerve was diagnosed. Furthermore, sensory neuropathy of both sural nerves and the right median nerve was also detected,” the authors write.

Routine blood tests were normal, but Western blot tests for Lyme disease were positive.

MRI results indicated the patient had “longitudinally extensive (> 3 segments) enlargement of the spinal cord mostly visible from C3 to C6/C7 level.”

Images also showed a hyperintense, spindle-like lesion in the central part of the spinal cord.

“An MRI of the optic nerve disclosed bilateral protrusion of the optic nerve heads, slight vertical tortuosity of both optic nerves, and bilateral hyperintense perioptic nerve sheath,” the authors explain.

“Together these signs could indicate elevated intracranial pressure,” writes Opielka.

Lyme infection triggers subacute transverse myelitis

Meanwhile, cerebral spinal fluid (CSF) tests detected antibodies against Borrelia burgdorferi (Bb). “The titers of anti-Bb IgM and IgG antibodies were significantly increased,” the authors write.

The woman was diagnosed with subacute transverse myelitis due to Borrelia burgdorferi infection. She received a 28-day course of intravenous (IV) ceftriaxone and her symptoms completely resolved.

“Our patient presented typical manifestations of [subacute transverse myelitis] SaTM with segmental swelling and enlargement of the spinal cord,” the authors write.

Additionally, she displayed another rare and frequently overlooked aspect of Lyme neuroborreliosis – optic nerve involvement.

Conclusion

“It is essential to consider [subacute transverse myelitis] SaTM when diagnosing [Lyme neuroborreliosis] LNB, especially in the endemic regions,” the authors conclude.

“Moreover, symptoms associated with optic nerve should also be considered when diagnosing patients with [Lyme neuroborreliosis] LNB.”

References:
  1. Walid MS, Ajjan M, Ulm AJ. Subacute transverse myelitis with Lyme profile dissociation. Ger Med Sci. 2008;6:Doc04. Published 2008 Jun 10.
  2. Opielka, M., Opielka, W., Sobocki, B.K. et al. Subacute transverse myelitis with optic symptoms in neuroborreliosis: a case report. BMC Neurol 20, 244 (2020). https://doi.org/10.1186/s12883-020-01816-y

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**Comment**

So thankful Dr. Cameron does these posts.

As you have seen from many of my recent posts our ‘authorities’ like Dr. Fauci push the idea of ‘Big Science’ which is large, placebo controlled double-blind studies.  Lyme/MSIDS has extremely few of those, but we do have many, many case studies.  These are not taken seriously by mainstream medicine but the information is out there for us to learn from.  When MSM finally accepts that this complex illness looks differently on everyone, perhaps they will begin accepting these smaller studies.

When I read this I couldn’t help thinking that few things cause spine stiffness, pain, and swelling but these symptoms are hallmark for Lyme disease.  I remember being barely able to twist my back to reverse my car.  The pain was excruciating.  Same with my neck which bothers me to this day and may never go back to normal.  Tremors, burning and prickling sensations are also hallmark symptoms.

The interesting thing about the cervical region, where the woman had extreme pain as well as nausea and vertigo, is that the vertebrae there differ from those in the rest of the spine in that each has openings to transport blood to the brain.  C1, also called the Atlas vertebra, supports the weight of the head.  Personally, I’ve had a lot of body work done in this area due to ongoing pain and stiffness.

Chiropractors who specialize and have a lot of extra training in this area are called Upper Cervical Chiropractors and are connected with NUCCA:  https://nucca.org It is quite different from standard chiropractic and involves no popping, twisting, or cracking. I also have trouble with my hips and by adjusting the atlas bone, my body self-adjusts all the way down eliminating my hip pain as well.  My entire family has benefitted from this treatment for different issues.  If you struggle with your neck and spine you should consider this treatment.

I’ve heard from many experienced and reputable doctors that Lyme loves the eyes:  https://madisonarealymesupportgroup.com/2020/04/15/rare-case-of-optic-neuropathy-caused-by-lyme-disease/

Lastly, I posted this some time ago for chiropractors as they may be who an undiagnosed or misdiagnosed patient sees first:  https://madisonarealymesupportgroup.com/2018/05/09/rheumatological-presentation-of-bartonella-koehlerae-henselae-a-case-report-chiropractors-please-read/  Although this is about a Bartonella infection, similar things can happen with Lyme and other coinfections.  Many patients are diagnosed by chiropractors and naturopaths who have an experienced eye and put two and two together.

Excerpt:

Please note the joint popping with each articulation and continual joint subluxation issue.  

Chiropractors need to be told about this.  Please educate!  Send them this article.

 

Cat Scratch Disease Imitating A Toxocara Granuloma of the Optic Disk

https://pubmed.ncbi.nlm.nih.gov/29176527/

CAT SCRATCH DISEASE IMITATING A TOXOCARA GRANULOMA OF THE OPTIC DISK

Affiliations expand

Abstract

Purpose: The study reports an unusual presentation of a young female patient presenting with a granulomatous posterior pole mass and profound vision loss secondary to infection with Bartonella henselae.

Methods: A single case report in a child.

Results: An 8-year-old female presented with a recent history of flu-like illness associated with profound vision loss, panuveitis and leukocoria in the left eye. She was found to have a posterior granulomatous mass associated with an exudative retinal detachment presumed as a toxocara granuloma. Magnetic Resonance Imaging ruled out retinoblastoma. Lab work done was negative for toxocariasis and positive for Bartonella henselae titers. She was treated for Cat Scratch Disease (CSD) with steroids and azithromycin. With treatment, the inflammation and exudative retinal detachment resolved, however, the patient had no improvement in visual acuity.

Conclusions: Young patients presenting with leukocoria need a full work up, which includes ruling out retinoblastoma. CSD can present as a granulomatous mass similar to toxocariasis, which can rarely lead to debilitating and irreversible vision loss.

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For more:  https://madisonarealymesupportgroup.com/category/bartonella-treatment/

https://madisonarealymesupportgroup.com/2019/09/07/keep-an-eye-out-for-bartonella/

https://madisonarealymesupportgroup.com/2017/04/06/ocular-bartonellosis/

 

Bartonella Neuroretinitis

https://pubmed.ncbi.nlm.nih.gov/32546517/

. 2020 Jun 16;practneurol-2020-002586.

doi: 10.1136/practneurol-2020-002586.Online ahead of print.

Bartonella Neuroretinitis (Cat-Scratch Disease)

Abstract

We report a patient with cat-scratch disease presenting with meningitis and neuroretinitis. This condition, caused by Bartonella henselae, has a worldwide distribution and is among the most common infective causes of neuroretinitis. Bartonella neuroretinitis is a rare but under-recognised mimic of optic neuritis; it should be suspected in a patient with an infective prodrome whose fundus shows optic disc oedema and a macular star. A low-positive initial serological test for Bartonella henselae does not exclude cat-scratch disease if there is high clinical suspicion, and repeat testing is recommended to look for titre rise.

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**Comment**

A negative test does not exclude Bartonella either.

For more:  https://madisonarealymesupportgroup.com/category/bartonella-treatment/

https://madisonarealymesupportgroup.com/2019/05/05/good-news-for-bartonella-patients-identification-of-fda-approved-drugs-with-higher-activity-than-current-front-line-drugs/

https://madisonarealymesupportgroup.com/2019/09/07/keep-an-eye-out-for-bartonella/

https://madisonarealymesupportgroup.com/2019/04/08/case-series-bartonella-ocular-manifestations/

https://madisonarealymesupportgroup.com/2018/09/06/ocular-manifestations-of-bartonellosis/

‘Rare’ Case of Optic Neuropathy Caused by Lyme Disease

https://www.ncbi.nlm.nih.gov/pubmed/32190461

2020 Feb 7;12(2):e6906. doi: 10.7759/cureus.6906.

A Rare Cause of Optic Neuropathy.

Abstract

Lyme disease is a multisystem infection caused by Borrelia burgdorferi that mainly affects the joints, the heart, and the nervous system. Neurological complications usually manifest in untreated patients and present as meningitis, cranial neuropathies, and radiculoneuritis. The authors present the case of a 48-year-old male who developed loss of vision in the right eye over a period of two months. On physical examination a relative afferent pupillary defect of the right eye was noted. Visual evoked potential test revealed delayed P100 latency bilaterally, confirming a bilateral optic neuropathy. The analysis of the cerebrospinal fluid (CSF) showed a lymphocytic meningitis. After an extensive work-up, a diagnosis of Lyme neuroborreliosis with meningitis and optic neuritis was made. The patient was treated with antibiotics and showed gradual improvement. The follow-up brain MRI revealed a mild T2 hyperintensity on the right optic nerve with gliosis, sequelae of the inflammatory process.

Lyme disease should always be considered in patients from endemic areas with nonspecific symptoms. The diagnosis of neuroborreliosis is challenging, but prompt identification and treatment can prevent the development of complications and sequelae.

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**Comment**

Again, just because there isn’t thousands of cases in the literature – doesn’t mean this is rare.  It’s only rare because so many go undiagnosed and testing misses over half of all patients.  If you type in eye or optic in the search bar on this website, you will quickly determine eye issues with Lyme is not rare at all.

https://madisonarealymesupportgroup.com/2019/02/01/erratic-eye-jerks-in-child-with-lyme/

https://madisonarealymesupportgroup.com/2018/08/17/case-of-optic-neuritis-secondary-to-lyme-disease/

https://madisonarealymesupportgroup.com/2017/07/21/growing-list-of-eye-problems-in-lyme-disease/

https://madisonarealymesupportgroup.com/2017/07/30/tick-inside-eye/

https://madisonarealymesupportgroup.com/2019/06/29/atypical-papillitis-an-isolated-manifestation-of-lyme-disease-which-isnt-isolated/

https://madisonarealymesupportgroup.com/2018/09/29/lyme-patients-check-your-vision/

https://madisonarealymesupportgroup.com/2020/01/13/infectious-keratitis-caused-by-rare-and-emerging-micro-organisms/

Lyme isn’t the only offender:  https://madisonarealymesupportgroup.com/2019/04/08/case-series-bartonella-ocular-manifestations/  Bartonella commonly causes eye issues.

Ocular Complications of Cat Scratch Disease

https://www.ncbi.nlm.nih.gov/pubmed/32122915/

2020 Mar 2. pii: bjophthalmol-2019-315239. doi: 10.1136/bjophthalmol-2019-315239. [Epub ahead of print]

Ocular complications of cat scratch disease.

Abstract

Cat scratch disease (CSD) in humans is caused by infection with Bartonella henselae or other Bartonella spp. The name of the disease reflects the fact that patients frequently have a history of contact (often involving bites or scratches) with infected cats. Patients with CSD typically develop lesions at the site where the skin is broken together with regional lymphadenopathy but may go on to exhibit systemic symptoms and with deep-seated infections at a range of sites including the eye. Patients with CSD may present with a range of inflammatory eye conditions, including Parinaud’s oculoglandular syndrome, neuroretinitis, multifocal retinitis, uveitis and retinal artery occlusion. Bartonella spp. are fastidious bacteria that are difficult to culture from clinical specimens so microbiological diagnosis is frequently made on the basis of positive serology for anti-Bartonella antibodies or detection of bacterial DNA by PCR. Due to the lack of clinical trials, the evidence base for optimal management of patients with CSD-associated eye infections (including the role of antibiotics) is weak, being derived from single reports or small, uncontrolled case series.

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**Comment**

This study states what the rest of us all know – there is a lack of research on Bartonella yet it is everywhere:  https://madisonarealymesupportgroup.com/2020/02/19/bartonella-infection-everywhere-but-we-dont-know-about-it/

https://madisonarealymesupportgroup.com/2019/04/24/human-bartonellosis-an-underappreciated-public-health-problem/

https://madisonarealymesupportgroup.com/category/bartonella-treatment/

https://madisonarealymesupportgroup.com/2019/01/02/bartonella-in-entire-canadian-family/

https://madisonarealymesupportgroup.com/2019/04/08/case-series-bartonella-ocular-manifestations/

https://madisonarealymesupportgroup.com/2018/09/06/ocular-manifestations-of-bartonellosis/

And please know you don’t have to be exposed to cats to get it:  https://madisonarealymesupportgroup.com/2018/07/10/bartonella-henselae-neuroretinitis-in-patients-without-cat-scratch/

You also don’t have to be immunocompromised to get it:  https://madisonarealymesupportgroup.com/2019/12/18/multifocal-hepatic-abscess-in-immunocompetent-patient-due-to-bartonella-henselae-case-report-with-review-of-literature/