Monosymptomatic bilateral inferior altitudinal hemianopsia associated with Borrelia burgdorferi
C. E. Uhlig* , S. Evers¨ , F. Stögbauer¨ , H. Gerding*
Introduction: Case report on an acute infection with Borrelia burgdorferi in a generally healthy 60-year old man with bilateral altitudinal hemianopsia .
Results: Initially the patient presented with a visual acuity of 20/20 on both sides, swollen optic discs with minor marginal bleedings and bilateral inferior altitudinal hemianopsia. On the left eye the scotoma was extending the horizontal line in the temporal field. VECP displayed on the rigth eye P-100 latency of 108 ms and on the left 125 ms. MRT scan revealed an atypical fluid enhancement surrounding the clinoidal and subclinoidal area. A clinical neurological examination did not provide any remarkable signs. Liquor results: Pressure was 10 cm H2O, lymphocyts 192/3, erythrocyts 18/3 and protein 642 mg/l. Liquor was positive for IgG, IgA and IgM. Liquor results proved an IgM production synthesized in the CNS. Specific IgM against Borrelia burgdorferi was detected in the liquor and serum. Treatment consisted of 1 g/d methylprednisolon and 1 g/d cephtriaxon during 24 days with step-wise reduction. Visual acuity deteriorated until 4 days after the first examination to 20/200 on both eyes and improved to 20/20 on the right and 40/200 - 20/50 on the left eye. Perimetric results ameliorated and presented better results 4 months later.
Conclusions: This case represents the first reported association of bilateral altitudinal hemianopsia related to CNS infection due to Borrelia burgdorferi. Clinical symptoms can be attributed to a bilateral ischemic optic neuropathy caused by an edematous shift in the anterior chiasmatic area.
University Clinics of Ophthalmology, Westfaelische Wilhelms-Universitaet Muenster, Domagkstr. 15, D-48129 Muenster
Department of Neurology, Westfaelische Wilhelms-Universitaet Muenster, Albert-Schweitzer-Str. 33, D-48129 Muenster