Neurol Neurochir Pol. 2001 Sep-Oct;35(5):803-13.
[Neuroborreliosis: CT and MRI findings in 14 cases. Preliminary communication]
Tarasow E, Ustymowicz A, Zajkowska J, Hermanowska-Szpakowicz T.
Zakladu Radiologii Akademii Medycznej w Bialymstoku.
Since 1987 when Januszkiewicz and Kieda first described borreliosis, it is commonly recognized as infection of the nervous system in Poland, especially in north-east region. The diagnosis of the disease is mainly based on typical clinical signs, supported by serological testing. In 14 patients with clinical symptoms of neuroborreliosis CT and MR were performed to evaluate CNS changes. MR examinations were abnormal in 36%. Most patients (60%) presented cerebral atrophy. In 2 cases areas of abnormal signal were identified within cerebral white matter as well as within the brain stem. In the first case it was, recognized as demyelination focus, in second one MR showed evidence of or were suggestive of vascular involvement. In one case symmetrical calcifications were also found in internal capsules. Neuroradiological signs in Lyme disease are not specific. Neuroborreliosis has to be considered when patients present foci of hyperintense signal (T2-weighted images) in white matter and brain stem.
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Case history. A 30 year old woman presented with depression and chronic fatigue. Review of systems revealed a history of fever, headache and rash 4 months ago.
Basic interpretation. T1-weighted non-contrast enhanced axial MRI (right) was normal. T1-weighted contrast-enhanced axial MRI (left) shows a small area of enhancement in the right anterior frontal lobe. The patient lived in a rural area endemic for Lyme disease. CSF had 24 lymphocytes and Lyme titers were positive. She received intravenous ceftriaxone with gradual resolution of symptoms of fatigue and depression. Follow-up contrast MRI was normal.
Advanced interpretation. Lyme disease is caused by burgdofer burgdoferei, a spirochetal organism. It rivals treponema pallidium (the organism causing syphillis) as the great imitator of neurologic disorders. It can affect the nervous system in many ways, causing meningitisencephalitimyelitis, and neuropathy. The encephalitis of Lyme disease is often subacute, causing a mild chronic fatigue syndrome lasting weeks to months. CT scan is not an adequate test for Lyme encephalitis.
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Inflammatory brain changes in Lyme borreliosis. A report on three patients and review of literature.
Oksi J, Kalimo H, Marttila RJ, Marjamaki M, Sonninen P, Nikoskelainen J, Viljanen MK.
Department of Internal Medicine, Turku University Central Hospital, Finland.
Despite a rapid increase in the number of patients with Lyme neuroborreliosis (LNB), its neuropathological aspects are poorly understood. The objective of this study was evaluation of neuropathological, microbiological, and magnetic resonance imaging (MRI) findings in three patients with the Borrelia burgdorferi infection and neurological disease from whom brain tissue specimens were available. Perivascular or vasculitic lymphocytic inflammation was detected in all specimens. Large areas of demyelination in periventricular white matter were detected histologically and by MRI in one patient. The disease had a fatal outcome in this patient. Brain MRI suggested malignancies in two patients before histopathological studies were carried out. One of these two patients was a child with sudden hemiparesis. Another was a 40-year-old man presenting with epileptic seizures and MRI-detected multifocal lesions, which disappeared after repeated courses of antibiotics. We conclude that cerebral lymphocytic vasculitis and multifocal encephalitis may be associated with B. burgdorferi infection. The presence of B. burgdorferi DNA in tissue samples from areas with inflammatory changes indicates that direct invasion of B. burgdorferi may be the pathogenetic mechanism for focal encephalitis in LNB
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