engleski

Pseudotumor cerebri associated with neuroborreliosis and intracranial sinus hypoplasia

Neuroborreliosis, an inflammation of the central nervous system caused by Borrelia burgdorferi sensu lato, is a relatively uncommon presentation of Lyme disease, occurring in approximately 3% of infected patients. Pseudotumor cerebri, defined as increased intracranial pressure without an intracranial mass or obstruction of cerebrospinal fluid (CSF) flow, is a rare symptom of neuroborreliosis. Increased intracranial pressure is occasionally associated with aplasia or hypoplasia of central venous collectors in otherwise healthy individuals. We present a 9- year-old girl with pseudotumor cerebri, neuroborreliosis and concomitant unilateral hypoplasia of sigmoid and transverse sinuses. She manifested with acute onset of headache, intermittent diplopia with right abducent nerve palsy and erythema migrans. Clinical presentation and laboratory investigations showed papilledema, EEG revealed diffuse slow activity, increased CSF pressure (opening pressure 600 mmH2O, stabilized at 400 mmH2O), CSF mild pleocytosis (18/3 lymphocytes) and positive serum and CSF anti- Borrelia burgdorferi antibodies. She was treated with ceftriaxone (2 g/day) for a total of 30 days. Diplopia receded after the lumbar puncture, headache and erythema migrans improved on antibiotic therapy. Infection of the central nervous system caused by Borrelia burgdorferi might be a trigger for development of pseudotumor cerebri in patients with intracranial sinus hypoplasia, leading to a rare manifestation of neuroborreliosis.

Pseudotumor cerebri; neuroborreliosis; intracranial sinus hypoplasia

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