THORACOABDOMINAL MANIFESTATION OF LYME NE UROBORRELIOSIS, STAGE-II

In the past little attention was paid to the thoracoabdominal manifest ation of Lyme radiculoneuritis, because paralysis of the abdominal wal l muscles was considered to be a very uncommon clinical manifestation of lyme neuroborreliosis. ln a group of 90 patients suffering from ear ly stage. Lyme neuroborreliosis we found abdominal wall weakness in 11 cases. In the majority of patients thoracoabdominal radiculoneuritis was located in he lower thoracic segments (Th 7-12) and involved more than 3 segments (62%) mostly bilaterally (69%). Abdominal wall paralys is was mostly bilateral (91%) and involved always the lower half of th e abdominal wall. It was very severe in 18%. Electromyographic studies were done in the paraspinal and abdominal wall muscles showing fibril lation potentials and positive sharp waves in 86% and 50%, respectivel y. Diagnosis of thoracoabdominal radiculoneuritis in Lyme neuroborreli osis may be difficult and diagnostic errors may occur. Therefore we re commend to look carefully for paralysis of the abdominal wall, which c an easily be overlooked on routine neurological examination. ln patien ts from an area with a high incidence of Lyme disease it is recommende d to exclude neuroborreliosis even in patients with known diabetes mel litus in order to avoid the misdiagnosis of diabetic thoracoabdominal radiculopathy. This has occurred in 2 of our patients.