Lyme disease versus psychosomatics
October 22, 2010 | 30,00 EUR | answered by Dr. med. Olaf Stephan
Background:
Hypersensitization since November 2009, swine flu vaccination September 2009, and flu vaccination Sep. 2009 (information about the last treatments)
Since 14.01.2010 unable to work, sudden dizziness and drowsiness with visual disturbances when putting on the backpack on the back before leaving the house in the morning to go to work (breakfast already eaten and enough fluids consumed). In the hallway, I felt strange, lay down on the sofa, and my mother drove me to the doctor. I felt better until I entered the doctor's office. In the waiting room, I felt strange in my head, everything was pulling me down. I was put on a cot by the assistant in the practice, couldn't stand on my feet, they kept giving way. The doctor came immediately, lying down I felt better, was responsive and conscious. Conscious and responsive, so no stroke. Doctor immediately called an ambulance, had to be taken out of the practice lying down, as I couldn't stand up, feeling drunk in my head.
Suspected Meniere's disease balance disorder,
in the hospital then ECG, blood count, urine, laboratory, Doppler sonography, CT head done on the same day as well as caloric balance test and audiometry ears, Frenzel glasses. All without findings, one week inpatient treatment neurology without medication AKH Celle. Continued there in the week, MRI head, swivel chair, auditory nerve test with headphones performed, dizziness diagnostics and balance organ okay.
All without findings. No Meniere's disease, head is okay. Nothing to be found, no signs of stroke, brain tumor, circulatory disorders, or inflammation in the head, etc.
So psychosomatic, discharge diagnosis: phobic dizziness, non-generalized anxiety disorder with panic attacks.
Weight loss from 67 KG to 55 KG in 6 weeks since the onset of the illness at a height of 174 and age of 39 years.
Beginning of February 2010 physiotherapy after Bobath ordered by HA. Massages done in between, so far over 60 !! KG treatments and massages incl. HWS and back, complaints have improved slightly.
March 2010 X-ray cervical spine, no findings in orthopedics, no cervical dizziness detectable.
Ophthalmologist March 2010 glaucoma prevention, slit lamp, fundoscopy, thorough eye examination, pupil dilation, intraocular pressure measurement, visual field, eye test, no nystagmus === all without findings, eyes are completely fine except for vitreous opacities that I have had for 20 years. Slightly dry right eye, but treated with drops and not causative for complaints.
Dentist: teeth okay, no abscesses, crossbite misalignment, professional teeth cleaning, got a bite splint, no improvement in complaints. A total of
Dear Inquirer,
It is not easy to respond to your very complex question, apparently it involves a long course of illness (approximately 3/4 year) with consultations and examinations by many specialist colleagues and departments, including hospitalization and rehabilitation measures. Regarding Borrelia serology, IgM antibodies have never been detected, but IgG antibodies have been detected multiple times. This finding speaks against a fresh infection with Borrelia (which are transmitted by ticks), as IgM antibodies should be detectable in that case, but it is compatible with a past or chronic infection. Given the colorful and nonspecific, sometimes changing neurological symptoms you described in detail, one should primarily consider a so-called neuroborreliosis, meaning a manifestation of the infection mainly in the peripheral or central nervous system. The original infection from the tick bite often goes unnoticed by many affected individuals, so the disease usually progresses for an indefinite period of time until the symptoms appear. The following signs of illness should also raise suspicion of neuroborreliosis:
- Severe nerve pain that does not respond to painkillers or the usual anti-inflammatory drugs (NSAIDs),
- Paralysis, especially in the legs and face,
- Numbness in the face and/or extremities,
- Sensations of heat and cold or chills,
- Severe and persistent headaches,
- Dizziness and balance problems,
- Vision disturbances (e.g. optic neuritis),
- Walking difficulties (e.g. unsteady gait),
- Cognitive impairments, e.g. concentration, memory, word finding difficulties,
- Persistent and severe fatigue and tiredness
Changes in personality,
Not all symptoms have to be present at the same time, they can also occur individually or sequentially. Acute early neuroborreliosis is usually accompanied by very severe signs of illness. The later course can be insidious or progress slowly. The diagnosis of neuroborreliosis (especially the chronic form) is often challenging. It can ultimately only be confirmed through a cerebrospinal fluid examination (cerebrospinal fluid analysis through lumbar puncture). In case of a suspected "Post-Lyme Disease Syndrome" or suspicion of chronic Lyme disease with nonspecific complaints, an extensive differential diagnosis should be conducted initially (depressive disorder, autoimmune disease, chronic infection of other origin, other internal chronic disease, alcohol/drug abuse). Another possible diagnosis for you would be Chronic Fatigue Syndrome (CFS). CFS is characterized by debilitating mental and physical fatigue/exhaustion as well as a specific combination of other symptoms. These include chronic fatigue, headaches, sore throat, joint and muscle pain, concentration and memory problems, non-restorative sleep, sensitivities of lymph nodes, and a persistent worsening of condition after exertion. Possible triggers here are especially intracellular pathogens like mycoplasma, chlamydia, or Borrelia, but also mycoses (fungal diseases) and viruses (Epstein-Barr virus). Furthermore, a large part of the symptoms you described could also be related to a condition called Pernicious Anemia (caused by a deficiency in Vitamin B12). Finally, it should be mentioned that in case of obstructive sleep apnea syndrome (loud snoring and pauses in breathing during sleep), increasing daytime fatigue and a further complex symptomatology can occur. I would also like to point out that the treatment with Venlafaxine can exacerbate teeth grinding during sleep. As you can see, answering your question is quite complex and may require further targeted investigations. Kind regards, O. Stephan.
