Lyme & MS

1: J Neurol Neurosurg Psychiatry 1998 May;64 Suppl 1:S6-14 Related
Articles, Books, LinkOut


Differential diagnosis of multiple sclerosis: contribution of magnetic
resonance techniques.

Triulzi F, Scotti G.

Department of Neuroradiology, Scientific Institute H S Raffaele, Milan,
Italy. triulzi.fabio@xxxxxx

It is widely accepted that magnetic resonance imaging (MRI) findings
are not totally specific for the diagnosis of multiple sclerosis. White
matter lesions that mimic those of multiple sclerosis may be detected
in both normal volunteers and patients harbouring different diseases.
Virtually all the characteristic features of multiple sclerosis are
sometimes encountered in other conditions affecting predominantly the
white matter. Different conditions such as vasculitis, subcortical
atherosclerotic leukoencephalopathy, Lyme disease, or acute
disseminated encephalomyelitis can be virtually indistinguishable from
multiple sclerosis on conventional MR images. Also the FLAIR technique
adds little to the differential diagnosis. The calculation of
magnetisation transfer ratio (MT ratio) may be useful to better
characterise some entities, such as vasculitis, from multiple
sclerosis.

Publication Types:
Review
Review, Tutorial

PMID: 9647278 [PubMed - indexed for MEDLINE]


1: Ital J Neurol Sci 1992 Dec;13(9 Suppl 14):85-90 Related Articles,
Books, LinkOut


Neurological complications of Lyme borreliosis.

Meier C.

Department of Neurology, University of Berne, Switzerland.

Lyme disease, like syphilis, a spirochetal infection, can appear with
exacerbations and remissions in different stages. The clinical picture
is marked by dermatological, neurological, rheumatic and cardiological
complications. PNS complications appear in the second and third stage.
Tick bite meningoradiculoneuritis neuritis
(Garin-Bujadoux-Bannwarth-Syndrome), characterized by painful
asymmetrical sensory and motor dysfunctions and inflamed CSF, is a
typical manifestation of the second stage. Mononeuritis multiplex
appearing in conjunction with acrodermatitis chronica atrophicans is a
typical PNS manifestation of the third stage. CNS involvement may also
occur in early and late stages of Lyme-Borreliosis, presenting as
myelitis or progressive encephalomyelitis. Lyme-Borreliosis is a
treatable condition, which should not be missed in the differential
diagnosis of PNS and CNS disorders.

Publication Types:
Review
Review, Tutorial

PMID: 1345745 [PubMed - indexed for MEDLINE]

1: Med Clin (Barc) 1989 Sep 9;93(6):218-20 Related Articles, Books,
LinkOut


[Meningoencephalomyelitis caused by Borrelia burgdorferi: a case
without epidemiologic history or chronic migratory erythema]

[Article in Spanish]

Ponz E, Graus F, Alvarez R, Sarmiento X, Vidal J, Grau JM.

A patient is reported with meningoencephalomyelitis with
polyradiculitis caused by Borrelia burgdorferi infection. Neurological
features developed without previously known tick bite nor the
characteristic skin lesion, chronic migratory erythema (CME). The
vector of the disease (the tick Ixodes ricinus) exists in Spain, but
only one case of meningopolyradiculitis with CME has been reported in
Asturias. Our case stresses that B. burgdorferi infection should be
suspected in cases of meningoencephalomyelitis or
meningopolyradiculitis even without previous skin or joint lesion.

PMID: 2601480 [PubMed - indexed for MEDLINE]


1: Rev Neurol (Paris) 1988;144(12):765-75 Related Articles, Books,
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[Multiple neurologic manifestations of Borrelia burgdorferi infection]
[Article in French]
Dupuis MJ.
Clinique St-Pierre, Ottignies, Belgique.
The neurological spectrum of Borrelia burgdorferi infections is still
enlarging. We review epidemiological, pathological and serological data
of Lyme disease. The course of the disease is divided in three stages:
stage 1 during the first month is characterised by erythema chronicum
migrans and associated manifestations; stage 2 includes not only the
classical European meningoradiculitis but also less specific
neurological symptoms: isolated lymphocytic meningitis with an acute or
even relapsing course, apparently idiopathic facial palsy, neuritis of
other cranial nerves, polyneuritis cranialis, Argyll-Robertson sign,
peripheral nerve involvement, acute transverse myelitis, severe
encephalitis, myositis. During stage 3, three to five months or longer
after the onset of the disease, chronic arthritis, acrodermatitis
chronica atrophicans and various neurological symptoms can be observed:
chronic neuropathy with mainly sensory or motor signs, recurrent
strokes due to cerebral angiopathy and progressive encephalomyelitis;
this third stage the central nervous system involvement is
characterised by slowly progressive or fluctuating course during months
or years, ataxic or spastic gait disorder, bladder disturbances,
cranial nerve dysfunction including optic atrophy and hypoacusia,
dysarthria, focal and diffuse encephalopathy. This chronic central
nervous system disease can mimic multiple sclerosis, anorexia nervosa,
psychic disorders or subacute presenile dementia. It is often
associated with pleiocytosis, abnormal EEG and evoked potentials,
sometimes multifocal and mainly periventricular white matter lesions
visualised by CT or MRI, and as a rule high antibody titers against
Borrelia burgdorferi. High doses of penicillin can halt the disease,
sometimes induce spectacular regression of symptoms or sometimes be
inefficient; ceftriaxone could be a more powerful therapy. Similarities
between syphilis and Borreliosis are multiple: both of these
spirochetes contain plasmids, can be transmitted through the placenta
and progress for many years through successive stages, with multiorgan
symptoms, including parenchymatous and vascular lesions of the central
nervous system. Borrelia burgdorferi is the new great imitator.
Publication Types: Review Review, Academic
PMID: 3070690 [PubMed - indexed for MEDLINE]

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1: J Neurol 1988 Jan;235(3):140-2 Related Articles, Books, LinkOut


Chronic borrelia encephalomyeloradiculitis with severe mental
disturbance: immunosuppressive versus antibiotic therapy.

Kollikowski HH, Schwendemann G, Schulz M, Wilhelm H, Lehmann HJ.

Neurologische Universitatsklinik und Poliklinik Essen, Federal Republic
of Germany.

A 57-year-old male was repeatedly admitted to hospital because of
complex neurological symptoms, including radicular pain, disturbance of
micturition, seizures, and severely impaired mental state. The
diagnosis was encephalomyeloradiculitis possibly of viral origin, and
treatment with immunosuppressants was initiated. An alternating course
with a tendency towards improvement ensued. Two and a half years after
the occurrence of the initial symptoms, identification of specific
antibodies in the blood and CSF led to the diagnosis of borreliosis
with CNS involvement. High-dose therapy with penicillin rapidly reduced
the symptoms, beginning with those of radicular pain and followed by an
improvement of the mental state. Attention is directed to the wide
spectrum of clinical symptoms of chronic borreliosis with CNS
involvement. Previous reports that immunosuppression may result in some
improvement but with a tendency towards relapse are confirmed. Our
encouraging treatment results support those of other reports that
penicillin therapy may lead to improvement even at late chronic stages
in patients with severe CNS deficits.

PMID: 3367160 [PubMed - indexed for MEDLINE]

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1: Nervenarzt 1989 Nov;60(11):706-9 Related Articles, Books, LinkOut


[Life-threatening encephalomyelitis in the 2d stage of Borrelia
burgdorferi infection]

[Article in German]

Lessmann JJ, Liedtke U, Nord L, Ackermann R.

Neurologische Abteilung, St. Johannes-Hospital, Arnsberg.

PMID: 2586693 [PubMed - indexed for MEDLINE]

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1: Curr Treat Options Neurol 1999 May;1(2):139-146 Related Articles,
Books
Neuroborreliosis (Nervous System Lyme Disease).

Halperin JJ.
North Shore University Hospital, 300 Community Drive, Manhasset, NY
11030, USA.

Treatment of nervous system Lyme disease depends on the severity and
site of involvement. Although some data indicate that uncomplicated
Lyme meningitis can be treated effectively with oral doxycycline,
central nervous system infection (meningitis, radiculitis,
encephalomyelitis, and cranial neuritis) is usually treated with
parenteral antibiotics for 14 to 30 days, depending on disease
severity, as is severe and progressive peripheral nervous system
involvement. Ceftriaxone, 2 g/d, is the most commonly used regimen;
cefotaxime, 2 g every 8 hours, appears to be equally effective.
Penicillin in meningeal doses is also effective, perhaps slightly less
so than the third-generation cephalosporins, but it is less convenient
to administer. For patients with prohibitive drug allergies, treatment
with oral doxycycline in doses of 300 to 400 mg/d may be effective. In
patients with facial palsy or with indolent peripheral neuropathies, a
trial of oral medication (doxycycline, 100 mg two or three times a day,
or amoxicillin, 500 to 1000 mg three times a day for 21 to 30 days) is
reasonable. Patients for whom this fails are treated with parenteral
medications.

PMID: 11096703 [PubMed - as supplied by publisher]




1: Pol Merkuriusz Lek 2000 Aug;9(50):584-8 Related Articles, Books


[Neurologic syndromes in Lyme disease]

[Article in Polish]

Zajkowska JM, Hermanowska-Szpakowicz T, Kondrusik M, Pancewicz SA.

Kliniki Chorob Pasozytniczych i Neuroinfekcji AM w Bialymstoku.

Lyme borreliosis, multisystem disease, when involve neurologic system
is named neuroborrelosis. Symptomatology of neuroborreliosis is rich
and various. Difficulties in recognition are connected usually with
long period from tick bite to late neurological signs. Any headache and
psychiatric disorder in the course of Lyme disease could be an early
manifestation of invasion of the CNS by the spirochaetes. Each part of
neurologic system could be involved. The most common clinical picture
of neuroborreliosis is meningitis with cranial or peripheral
neuropathies connected with radiculalgia, less common are encephalitis
and myelitis, neuropathies and polyneuropathies, encephalopathies.
Encephalomyelitis is the most serious form of neuroborreliosis. From
the pathophysiologic point of view all cranial and peripheral
neuropathies are forms of mononeuritis multiplex. Vasculitis and
autoimmunology processes are present. Encephalopathy is due to
neuroimmunomodulators, like lymphokines and by toxico-metabolic effect
could be connected with each form of systemic borreliosis. Spheroplast
L-form of borrelia could be responsible for difficulties with their
eradication. Diagnosis of neuroborreliosis is based on culturing of B.
burgdorferi from CSF, detection of specific antispirochaetal antibodies
produced in subarachnoid space, detection of activated lymphocytes,
other antigens detection in CSF (also after dissociation of complexes)
or borrelial DNA sequences.

Publication Types:
Review
Review, Tutorial

PMID: 11081332 [PubMed - indexed for MEDLINE]

h Fr Pediatr 1990 Jan;47(1):39-41 Related Articles, Books, LinkOut
[Meningo-encephalomyelitis in Lyme disease]
[Article in French]
Pincemaille O, Pin I, Wroblewski I, Francois P, Gratacap B, Joannard A,
Bost M.
Service de Medecine Infantile, C.H.R.U. de Grenoble.

A case of isolated central nervous system involvement in Lyme disease
is described. A 13 year-old boy developed progressive spastic
quadraparesis, chronic lymphocytic meningitis with a low CSF glucose
concentration and demyelinating lesions of the white matter on MRI. The
diagnosis was proved serologically by high antibody titers against
Borrelia burgdorferi (BB) in the serum (1:5, 120) and CSF (1:1,280).
There was evidence of specific intrathecal immune response against the
BB antigen. The patient was treated with penicillin G and then
ceftriaxone. The CSF abnormalities quickly improved but improvement of
the neurologic symptoms was gradual and to date still incomplete.

PMID: 2322077 [PubMed - indexed for MEDLINE]

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1: Arch Phys Med Rehabil 2000 Apr;81(4):519-21 Related Articles, Books,
LinkOut

Lyme neuroborreliosis mimics stroke: a case report.
Zhang Y, Lafontant G, Bonner FJ Jr.

Department of Physical Medicine and Rehabilitation, Graduate Hospital,
Philadelphia, PA, USA.

Lyme neuroborreliosis is diagnostically challenging because of its
diverse manifestations. The well-documented neurologic spectrum
includes lymphocytic meningitis, cranial neuropathy, and
radiculoneuritis in the early disseminated stage; and peripheral
neuropathy, chronic encephalomyelitis, and mild encephalopathy in the
late persistent stage. This case report describes a 74-year-old man who
developed progressive left hemiparesis and facial palsy. The patient
was hospitalized to rule out a cerebral vascular accident. The
diagnosis of Lyme borreliosis was established with serologic studies.
The patient was treated with intravenous ceftriaxone and responded with
rapid clinical and functional recovery. Lyme neuroborreliosis
presenting as hemiparesis has rarely been reported. Prompt diagnosis
and treatment appear to facilitate symptomatic relief and prevent
persistent neurologic deficits.

PMID: 10768546 [PubMed - indexed for MEDLINE]



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1: Folia Neuropathol 1999;37(1):43-51 Related Articles, Books, LinkOut



Central nervous system infection caused by Borrelia burgdorferi.
Clinico-pathological correlation of three post-mortem cases.

Bertrand E, Szpak GM, Pilkowska E, Habib N, Lipczynska-Lojkowska W,
Rudnicka A, Tylewska-Wierzbanowska S, Kulczycki J.

Department of Neuropathology, Institute of Psychiatry and Neurology,
Warszawa.

The spirochete Borrelia burgdorferi (B. burgdorferi) may cause severe
meningoencephalomyelitis as the sole manifestation of Lyme borreliosis.
We would like to present three such cases, where definite
neuroborreliosis was clinically diagnosed in two cases and possible
neuroborreliosis was recognized in one case. Alive spirochetes were
isolated and cultured from blood and cerebrospinal fluid (CSF) in both
definite cases. B. burgdorferi as the causative agent of the infection
was confirmed in CSF by polymerase chain reaction (PCR) in one definite
case. In the possible case spirochetes were cultured from blood and
CSF. Alive spirochetes were not isolated, however anti-B. burgdorferi
antibody value in serum was significantly elevated. On necropsy gross
examination brain edema without focal changes was detected in two
cases. Cerebral atrophy was seen in Case 3. Microscopically,
lymphocytic infiltrates, microglial diffuse and nodular activation,
spongiform changes, diffuse demyelination of the cerebral and
cerebellar white matter, and diffuse astrocytosis, were characteristic
pathological features in all presented cases. Multifocal, perivascular
degenerative changes in the cerebral and cerebellar white matter were
observed in the first case. Inflammatory changes in the nuclei and
roots of cranial nerves were present in the third case.

PMID: 10337063 [PubMed - indexed for MEDLINE]

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1: Neurol Neurochir Pol 1998 Jan-Feb;32(1):111-24 Related Articles,
Books, LinkOut


[Neurologic borreliosis]

[Article in Polish]

Zajkowska JM, Pancewicz SA, Hermanowska-Szpakowicz T.

Kliniki Chorob Pasozytniczych i Neuroinfekcji AM, Bialymstoku.

Any headache in the course of Lyme disease could be an early
manifestation of invasion of the CNS by spirochaetes. The most
characteristic symptoms of early neuroborreliosis are meningitis with
cranial or peripheral neuropathies connected with radiculopathies, less
common are encephalitis and myelitis, neuropathies, polyneuropathies,
encephalopathies. Encephalomyelitis is the most serious form of
neuroborreliosis. From the pathophysiologic point of view all cranial
and peripheral neuropathies are forms of mononeuritis multiplex.
Encephalopathy is due to neuroimmunomodulators, like lymphokins and or
by toxico-metabolic effect could be connected with each form of
systemic borreliosis. Certain diagnosis of neuroborreliosis is based on
culturing of B. burgdorferi from CSF, detection of specific
antispirochaetal antibodies produced in the subarachnoid space,
detection of activated lymphocytes B producing specific antibodies,
detection in CSF of other antigens of B. burgdorferi or DNA sequences.

PMID: 9631383 [PubMed - indexed for MEDLINE]

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1: Br Med J 1970 Jan 3;1(687):30-2 Related Articles, Books, LinkOut


Rickettsial antibodies in multiple sclerosis.

Field EJ, Chambers M.

PMID: 4983591 [PubMed - indexed for MEDLINE] 1: Acta Virol 1982
Sep;26(5):403 Related Articles, Books, LinkOut


Isolation of the tick-borne encephalitis virus from a patient with
multiple sclerosis.

Vagabov RM, Skvortsova TM, Gofman YuP, Barinsky IF.

PMID: 6128910 [PubMed - indexed for MEDLINE]

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1: J Neurol 1987 Jan;234(1):40-3 Related Articles, Books, LinkOut


Chronic progressive neurological involvement in Borrelia burgdorferi
infection.

Weder B, Wiedersheim P, Matter L, Steck A, Otto F.

Five patients with chronic meningitis were hospitalized several times
for
progressive neurological symptoms. The clinical manifestations included
cranial
neuritis, radiculoneuritis, myelitis and encephalitis. In two cases
cerebral
infarction occurred. The course was commonly characterized by a
tendency to
deteriorate. From the clinical point of view, it was repeatedly
difficult to
exclude multiple sclerosis or tuberculous meningitis. Finally, specific
antibodies against Borrelia burgdorferi were detected by indirect
immunofluorescence assay. The diagnosis of a borreliosis was not
considered
initially because there was no history of tick-bite or erythema
chronicum
migrans, and the neurological involvement of the central nervous system
seemed
unusual. The latency between the first symptoms and diagnosis varied
from 3
months to 5 years. After a parenteral, high-dose therapy with
penicillin, there
was a significant improvement in all patients. In two cases, there was
evidence
of intrathecally produced antibodies to myelin basic protein.

PMID: 3819785 [PubMed - indexed for MEDLINE]


1: Rev Neurol (Paris) 1988;144(6-7):416-20 Related Articles, Books,
LinkOut


[Borrelia burgdorferi encephalomyelitis]

[Article in French]

Depre A, Sindic CJ, Bukasa K, Bigaignon G, Laterre C.

Laboratoire de Neurochimie, Cliniques Universitaires Saint-Luc,
Universite
Catholique de Louvain, Bruxelles, Belgique.

We report two patients with chronic encephalomyelitis due to Borrelia
burgdorferi in whom the definite diagnosis was delayed because of
atypical
clinical features. The first patient presented with chronic spastic
paraparesis, slight ataxia and nystagmus of several years' duration. A
tentative diagnosis of multiple sclerosis was made in spite of
important
abnormalities of the CSF biological characteristics. The second patient
presented with an acute aphasia and a bilateral Babinski's sign. He was
thought
to suffer from benign herpetic meningoencephalitis. Several months
later, as
the patient experienced relapses with cerebellar and spinal cord
involvement,
falsely positive tests for syphilis were found and an antibiotic
treatment was
given. High protein content, low glucose levels, pleocytosis and
oligoclonal
bands were observed in all CSF samples, but the definite diagnosis was
based on
the detection of serum and CSF antibodies against B. burgdorferi.

PMID: 3187297 [PubMed - indexed for MEDLINE]




1: Ter Arkh 1996;68(5):41-4 Related Articles, Books, LinkOut


[Chronic neuroborreliosis in Lyme disease]

[Article in Russian]

Logigian EL.

Acute and chronic syndromes of Lyme neuroborreliosis are recognized.
Acute syndromes are clinically pronounced and comprise meningitis,
neuritis of the cranial nerve, radiculoneuritis. Chronic syndromes are
less evident. These are moderate encephalopathy and radiculoneuropathy.
The diagnosis of the chronic syndrome is based on the presence of early
classic signs of BL. CSF must be tested for routine procedure and in
pair with serum in the test for selective accumulation of antibodies to
Bb in the CSF. Neurophysiological studies help detect memory defects.
Electrophysiological tests verify radiculoneuropathy. NMR investigation
of the brain and SPECT-scanning may demonstrate damage to the white
brain matter. We have much experience with i.v. administration of
ceftriaxone (2 g/day for 4 weeks) which relieved neurological syndromes
several months later.

PMID: 9082597 [PubMed - indexed for MEDLINE]
1: Glas Srp Akad Nauka [Med] 1993;(43):225-8 Related Articles, Books,
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[Chronic encephalomyelitis caused by Borrelia burgdorferi. Case report]

[Article in Serbo-Croatian (Cyrillic)]

Pavlovic D, Levic Z, Dmitrovic R, Ocic G.

We present a female patient with typical third stage neuroborreliosis
with progressive chronic encephalomyelitis. One month after a tick
bite, in the first stage of Lyme disease, she had myalgias during ten
days and after one year polyarthralgias and polyarthritis. Neurological
problems occurred 15 years after the tick bite with headache,
nystagmus, intentional tremor and spastic paraparesis with sphincter
disturbances. Etiological diagnosis was established after three years.
Cytobiochemical findings in cerebrospinal liquor were normal but
oligoclonal IgG bands were found. Fluorescent antibody test was
positive in serum (1:75) as well as ELISA (1:447). The patient reacted
favourably to intravenous crystal penicillin 20 x 10(6) units daily
during 18 days. Till now, she is in remission and has only mild paresis
of the left leg.

PMID: 8262411 [PubMed - indexed for MEDLINE]

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