_Arch Dis Child._
(javascript:AL_get(this,%20'jour',%20'Arch%20Dis%20Child.');) 2010 Jun 28. [Epub ahead of print]
Clinical presentation of childhood neuroborreliosis; neurological
examination may be normal.
_Broekhuijsen-van Henten DM_
(http://www.ncbi.nlm.nih.gov/pubmed?term="Broekhuijsen-van%20Henten%20DM"[Author]) , _Braun KP_
(http://www.ncbi.nlm.nih.gov/pubmed?term="Braun%20KP"[Author]) , _Wolfs TF_
(http://www.ncbi.nlm.nih.gov/pubmed?term="Wolfs%20TF"[Author]) .
Department of Paediatrics, Isala Clinics, Zwolle, The Netherlands.
Abstract
Objective
Neuroborreliosis has its highest incidence in children and the older
people. Signs and symptoms are different between the different age groups. The
aim of this study was to describe the clinical spectrum of neuroborreliosis
in children.
Design
The Dutch Paediatric Surveillance system registered cases of childhood
neuroborreliosis during 2 years. All Dutch paediatric hospitals took part in
this surveillance. Criteria for reporting cases were strictly defined.
Results
89 cases of neuroborreliosis were reported; in 66 cases diagnosis was
confirmed. Facial weakness was one of the presenting symptoms in 47 cases (71%)
and the only symptom in nine children (14%). The five complaints most
frequently reported were: malaise, headache, fatigue, fever and neck pain. 52
children (79%) had one or more objective neurological signs at presentation,
of which facial nerve palsy, other cranial nerve abnormalities and
meningeal signs were most frequent. 14 patients (21%), however, had no
neurological signs at physical examination. In these patients, the number of
subjective complaints was higher, and the time interval to diagnosis was longer
compared with those with objective neurological abnormalities.
Conclusions
In this study, 79% of paediatric neuroborreliosis patients presented with
neurological signs, most often facial nerve palsy. 21% presented in an
atypical way without neurological signs. A thorough neurological examination is
essential once neuroborreliosis is considered in children. Even in the
absence of neurological signs, neuroborreliosis may be suspected in children
with typical antecedents and multiple symptoms. Cerebrospinal fluid
investigations are then required to confirm the diagnosis.
PMID: 20584849 [PubMed - as supplied by publisher]
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