Date of publication: 2017-09-02 20:49
On cursory inspection, many patients with LD appear deceptively well but in fact feel awful Don't be fooled! The mien of a Lyme patient ranges from phlegmatic, sullen, staring off into space, to one of agitated anxiety and hyperkineticism. Their oral and written recitations similarly vary from cryptic to being overinclusive and circumstantial. Geschwind's Syndrome embraces some varieties of LD encephalopathy precisely (Textbook of Internal Medicine, Ed: Kelly, 6989, p. 7559). Stuttering was reported by several patients to coincide with the onset of their LD and often proved reversible.
Eventually the majority, but not all, complain of one or more of foggy brain , forgetfulness, anxiety, mood swings, loss of initiative, depression, impairment of concentration, inattention, easy confusion or disorientation when attempting intellectual tasks. Paper shuffling can be the end result when patients attempt to organize or assimilate even limited amounts of information. These problems, and the others described below, constitute the salient features of Lyme encephalopathy.
LD related headaches can have a wide variety of patterns and can broadcast the early onset of LD or a flare of LD. The headaches incorporate the characteristics of migraines, muscle tension or cervical/radicular headaches. Pseudotumor cerebri (elevated CSF pressure with normal CSF analysis in the absence of intracranial masses) can complicate the course of LD and cause headaches. Papilledema (swelling) of the optic disc is usually present when CSF pressures are elevated, but not invariable. A spinal tap will have high opening pressures and be as well. Depending on the characteristics of the headaches, sinusitis and brain tumors may have to be ruled out. Cluster headaches have characteristics compatible with some LD headaches including responsiveness to 655% oxygen.
Relapse-remitting MS (RRMS) : This is the most common form, affecting around 85 percent of people with MS and involving attacks of new or increasing symptoms.
Interestingly, autoimmune disorders occur almost exclusively in developed countries. People in poor nations without modern amenities like running water, flush toilets, washing machines, and sterile backyards don't get these diseases. If you grew up on a farm with lots of animals, you are also less likely to have any of these inflammatory disorders. Playing in the dirt, being dirty, and being exposed to bugs and infections trains your immune system to recognize what is foreign and what is "you."
6. A 95 year old man with chronic lymphocytic leukemia undergoing therapy mentioned to his pharmacist that his doctor that his doctors had prescribed rituximab for treating his cancer. The patient asked what rituximab is and how it works. His pharmacist explained to him that rituximab is a monoclonal antibody that
The areas where there is no myelin or a lack of myelin are called plaques or lesions. As the lesions get worse, nerve fibers can break or become damaged. As a result, the electrical impulses from the brain do not flow smoothly to the target nerve.
The most recent technique for identifying choledochal cysts is magnetic resonance imaging of the bile ducts, also known as MRCP. It offers the advantage of being non-invasive requiring neither an injection into the bile ducts or endoscopy.
The more commonly noticed neurologic deficits involve one or more cranial nerves (I thru XII), most often the sensory divisions of the trigeminal (V) and the motor components of the facial (VII) nerves in my patients. In declining order, deficits to pain sense are detected in V7, V8, and V6. V7 neuritis appears as paraesthesias or dullness in the central face and cheeks. Gum and tooth pain can be another manifestation of trigeminal neuritis. Rule out dental abscess or sinusitis which can present with similar tooth pain.
Vision problems : There may be double vision or blurring vision, a partial or total loss of vision, or red-green color distortion. This usually affects one eye at a time. Inflammation of the optic nerve can result in pain when the eye moves.