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http://www.google.com/search?q=cache:A54mdESBRYQJ:www.aaem.pl/pdf/aae... .pdf+diaphragmatic+palsies+lyme&hl=en Page 1 CASE REPORTS AAEM Ann Agric Environ Med 2001, 8, 95–97 Received: 25 April 2001 Accepted: 4 June 2001 DYSARTHRIA AS THE ISOLATED CLINICAL SYMPTOM OF BORRELIOSIS. A CASE REPORTDYSARTHRIA AS THE ISOLATED CLINICAL SYMPTOM OF BORRELIOSIS. A CASE REPORT Katarzyna Gustaw1, Urszula Mirecka 21Outpatients Neurological Department, Institute of Agricultural Medicine, Lublin Poland 2Department of Logopedics and Applied Linguistics, Maria Curie-6NáRGRZVND 8QLYHUVLW /XEOLQ 3RODQGGustaw K, Mirecka U: Dysarthria as the isolated clinical symptom of borreliosis - a case report. Ann Agric Environ Med 2001, 8, 95–97. Abstract: This report presents a case of dysarthria due to hypoglossal nerve mono-neuropathy as the only consequence of neuroborreliosis. The 65-year-old man with a seven-months history of articulation disturbances was examined. The speech of the patient was slow and laboured. A slight weakness of the muscles of the tongue (left-side) was observed. The patient suffered from meningitis due to Borrelia burgdorferiinfection in 1999 and initially underwent a successful antibiotic treatment. Detailed radiological investigation and psychological tests were performed and co-existing neurological diseases were excluded. To describe profile of speech abnormalities the dysarthria scale was designed _base_d on S. J. Robertson Dysarthria Profile. There were a few disturbances found in self-assessment of speech, intelligibility, articulation, and prosody but especially in the morphology of the articulation muscles, diadochokinesis, the reflexes (in the mouth, larynx and pharynx). Needle EMG examination confirmed the diagnosis of mono-neuropathy of left hypoglossal nerve. The study confirms the fact that neuroborreliosis may evoke chronic consequences. INTRODUCTION Dysarthria is a speech disorder due to a weakness or poor coordination of the speech muscles. It is often a symptom of a disease, such as cerebral palsy, muscular dystrophy and cranial nerves abnormalities. Dysarthria can result from head injury or cranial nerves neuropathy, and from neuritis due to infections. In the case of XII cranial nerve disturbances, speech is slurred or otherwise difficult to understand due to lack of ability to produce speech sounds correctly. In literature to date, long term effects of neuroborreliosis were often described with loss of peripheral nervous system function. In the course of borreliosis, deficits of almost all cranial nerves have been recently described [3, 4, 6, 7, 9, 10, 11, 12, 13, 14, 15]. The isolated XII left cranial nerve (hypoglossal nerve) dysfunction, however, has never been described before. The purpose of this study was the delineation and assessment of dysarthria profile as the only neurological effect of mono-neuropathy of the XII cranial nerve in the course of neuroborreliosis. PATIENT The 65-year-old patient underwent acute meningitis due to Borrelia infection in 1999. The diagnosis was _base_d on the history of tick bite associated with the typical clinical presentation of the severe meningitis. Fever, meningism, and nausea were noticed. Detection of lymphocyte pleocytosis in lumbar puncture and anti-Borrelia antibodies in the ELISA test with the samples of
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