March 24, 2023

So per request somebody want us to talk about lyme disease and neuroborrelliosis which is kind of the neuroop version of lyme disease and you should know that there this is a tick-borne illness and the organism is borrelia bergdorferi and it’s the deer tick that transmits the organism and so one of the things we need to know is a little bit about the epidemiology

Of how did the person get this line now lyme has a countrywide distribution but in the united states 95 plus cases come from just four parts of our country so if you’re looking at the united states really it’s going to be the northeast corridor centered on the famous lyme connecticut but all of these parts of the new england martha’s vineyard all those places

And then we’ve got this chunk in the middle here which is like minnesota wisconsin this midwest piece and then you got this northwest corridor here like washington state oregon and then you got scattered communities in the in the south and in other places that have less but it’s not endemic like it is to the northeast so when we see patients in texas which is a

Not endemic part for lime we’d like to know where did you go oh i was in minnesota fishing what’d you do i was camping outdoors and what time of year was it it was may or the spring and did you have a tick bite the second thing we want to know is if they had a rash and even though the book says the rash should be a target-like lesion it really can look like a lot

Of different things however the one we’re looking for is called erythema chronic of migraines which is going to be a bullseye type target lesion with a central clearing on an erythematous base ecm erythema chronic migrants and so this comes to us just like syphilis so anytime you have syphilis in the differential you also have them lyme like syphilis there’s a

Primary a secondary and a tertiary stage and so for neurop we’re often seeing the patient in the tertiary stage in the secondary stage just like syphilis it’s the uveitis phase and the primary i never get to see that because that’s the tick bite and erythema chronic migraines so in this acute primary stage is the non-eye finding part for neurop we are normally

Seeing tertiary and secondary a lot but here in texas they have had to travel to an endemic area or b from an endemic area before i’m going to consider the line and for lyme disease we have a two tier testing strategy the first tier is the screening which is the elisa an enzyme-linked immunoabsorbent assay and this test is not very sensitive and specific and

So you have to do a confirmatory gold standard which is the western blot the western blot is going to have bands and the cdc has defined exactly which numbers you have to have and i can never memorize them so it’s like number 39 number 43 number 52 so it’s like bingo if you have five of these bingo because you’ve got a 39 a 43 a 52 and you have to look up all

Those numbers and then and the types that we are looking for and then if you have any kind of itis that is what we’re looking for so from the front to the back episcleritis conjunctivitis scleritis keratitis kirito conjunctivitis iritis intermediate uveitis vitritis retinitis optic neuritis meningitis meningoencephalitis cranial neuropathyitis it’s just itis

Basically and that’s why it’s always in the differential diagnosis for neurop because it can look like anything so it’s one of those great mimickers just like syphilis and sarcoidosis and of course the treatment you should leave to infectious disease they’re going to have their own regimens in terms of tetracycline derivatives versus ceftriaxone it’s constantly

Changing we’re going to do the lumbar puncture to look for evidence of cns disease and if they’re treated with antibiotics the cdc says it’s a one and done so however you need to know that there’s a chronic form of lyme that is very controversial and is referred to as post treatment lyme disease syndrome and so those patients often have chronic fatigue and they

Have chronic unexplained residual symptoms even though they don’t have the itis anymore so these post treatment lyme disease syndrome patients can come to you in neurop but i just look for the itis and optic atrophy so if i don’t see any objective finding they’ve already been treated with antibiotics then i just reassure them and let them be treated by whoever

They’re being treated by for homeopathic or non-western alternatives but the official party line of the infectious disease society of north america and the cdc is once you’ve been treated for antibiotics that that’s that’s the end of the treatment but there is this post treatment syndrome that exists so the patients do have symptoms so you need to know a little

Bit about lyme disease it can present to me as neuro borreliosis you should ask them where they went what they do what time of year it was if they had a tick bite the rash of anthem of chronic migraines look for itis treat them with antibiotics got all that

Transcribed from video
Lyme Disease By Neuro-Ophthalmology with Dr. Andrew G. Lee