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Startle myoclonus induced by Lyme neuroborreliosis: a case report

INTRODUCTION: The normal startle response is a form of physiological myoclonus. Its anatomic origin is probably the brain stem. Pathologic startles are defined as reproducible exaggerated startle responses to trivial and not surprising stimuli. Symptomatic forms of an exaggerated startle response ca...

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Autores principales: Schoof, Julia, Kluge, Christian, Heinze, Hans-Jochen, Galazky, Imke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667138/
https://www.ncbi.nlm.nih.gov/pubmed/23668751
http://dx.doi.org/10.1186/1752-1947-7-124
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author Schoof, Julia
Kluge, Christian
Heinze, Hans-Jochen
Galazky, Imke
author_facet Schoof, Julia
Kluge, Christian
Heinze, Hans-Jochen
Galazky, Imke
author_sort Schoof, Julia
collection PubMed
description INTRODUCTION: The normal startle response is a form of physiological myoclonus. Its anatomic origin is probably the brain stem. Pathologic startles are defined as reproducible exaggerated startle responses to trivial and not surprising stimuli. Symptomatic forms of an exaggerated startle response can be due to a variety of brain stem disorders. We have, however, found scant data about an exaggerated startle reflex induced by Lyme neuroborreliosis. We therefore report the case of a patient with this unusual presentation. CASE PRESENTATION: A 69-year old Caucasian man presented with a two-week history of a pronounced startle myoclonus, as well as a four-week history of double vision, gait disturbance and severe lancinating pain in his upper thoracic region. Neurological examination showed an excessive startle reaction of his upper trunk evoked by visual and tactile stimulation, a positive sign of Lhermitte, mild right-sided palsy of his sixth and seventh cranial nerve, moderate dysarthria, very brisk deep tendon reflexes, pallhypesthesia of his legs, and an atactic gait disturbance. A diagnosis of a Lyme neuroborreliosis was confirmed by cerebrospinal fluid examination. Under intravenous treatment with ceftriaxone, our patient improved considerably with complete remission in a follow-up at two months. CONCLUSIONS: This case illustrates the chameleon role that neuroborreliosis likes to play: although the wide spectrum of different symptoms that neuroborreliosis can present with has been described, to the best of our knowledge this is the first case report about a symptomatic form of a pathologic startle response as the predominating sign of Lyme neuroborreliosis.
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spelling pubmed-36671382013-05-30 Startle myoclonus induced by Lyme neuroborreliosis: a case report Schoof, Julia Kluge, Christian Heinze, Hans-Jochen Galazky, Imke J Med Case Rep Case Report INTRODUCTION: The normal startle response is a form of physiological myoclonus. Its anatomic origin is probably the brain stem. Pathologic startles are defined as reproducible exaggerated startle responses to trivial and not surprising stimuli. Symptomatic forms of an exaggerated startle response can be due to a variety of brain stem disorders. We have, however, found scant data about an exaggerated startle reflex induced by Lyme neuroborreliosis. We therefore report the case of a patient with this unusual presentation. CASE PRESENTATION: A 69-year old Caucasian man presented with a two-week history of a pronounced startle myoclonus, as well as a four-week history of double vision, gait disturbance and severe lancinating pain in his upper thoracic region. Neurological examination showed an excessive startle reaction of his upper trunk evoked by visual and tactile stimulation, a positive sign of Lhermitte, mild right-sided palsy of his sixth and seventh cranial nerve, moderate dysarthria, very brisk deep tendon reflexes, pallhypesthesia of his legs, and an atactic gait disturbance. A diagnosis of a Lyme neuroborreliosis was confirmed by cerebrospinal fluid examination. Under intravenous treatment with ceftriaxone, our patient improved considerably with complete remission in a follow-up at two months. CONCLUSIONS: This case illustrates the chameleon role that neuroborreliosis likes to play: although the wide spectrum of different symptoms that neuroborreliosis can present with has been described, to the best of our knowledge this is the first case report about a symptomatic form of a pathologic startle response as the predominating sign of Lyme neuroborreliosis. BioMed Central 2013-05-13 /pmc/articles/PMC3667138/ /pubmed/23668751 http://dx.doi.org/10.1186/1752-1947-7-124 Text en Copyright © 2013 Schoof et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Schoof, Julia
Kluge, Christian
Heinze, Hans-Jochen
Galazky, Imke
Startle myoclonus induced by Lyme neuroborreliosis: a case report
title Startle myoclonus induced by Lyme neuroborreliosis: a case report
title_full Startle myoclonus induced by Lyme neuroborreliosis: a case report
title_fullStr Startle myoclonus induced by Lyme neuroborreliosis: a case report
title_full_unstemmed Startle myoclonus induced by Lyme neuroborreliosis: a case report
title_short Startle myoclonus induced by Lyme neuroborreliosis: a case report
title_sort startle myoclonus induced by lyme neuroborreliosis: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667138/
https://www.ncbi.nlm.nih.gov/pubmed/23668751
http://dx.doi.org/10.1186/1752-1947-7-124
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