My thanks in advance to Yvonne and Joe Hamm, for finding these additional abstracts at LNE:
Arch Neurol. 1991 Aug;48(8):832-6.
Borrelia rhombencephalomyelopathy. Kuntzer T, Bogousslavsky J, Miklossy J, Steck AJ, Janzer R, Regli F.
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Three patients, in whom the diagnosis of Borrelia burgdorferi infection was unknown for several years, developed a biphasic involvement of the central nervous system: an acute brain-stem dysfunction was followed up, in two patients, by a progressive, disabling myelitis and, in one patient, by further relapsing-remitting episodes of severe multifocal rhombencephalitis. The most consistent cerebrospinal fluid abnormalities in the analysis of sequential specimens were elevated total IgM levels that normalized after penicillin therapy. The neuropathologic findings in one patient showed microgliosis and meningovascular involvement of the central nervous system, resulting in two ischemic infarcts in the myelencephalon. Few spirochetes were localized in the leptomeninges and around subependymal vessels of the fourth ventricle. The vascular element consisted of an obliterative inflammatory vasculopathy in the medullary parenchyma. This study (1) provides pathologic evidence that a vascular disease induced by B burgdorferi is a pathogenetic mechanism for cerebrovascular diseases, and (2) emphasizes the similarities between neuroborreliosis and neurosyphilis.
PMID: 1898257 [PubMed - indexed for MEDLINE]
www.ncbi.nlm.nih.gov/pubmed/1898257______________________________________________________
Screening for neuroborreliosis in patients with strokeS Hammers-Berggren, A Grondahl, M Karlsson, M von Arbin, A Carlsson and G Stiernstedt
Department of Infectious Diseases, Danderyd Hospital, Sweden.
BACKGROUND AND PURPOSE: Borrelia burgdorferi, the etiologic agent of Lyme disease, can cause different neurological manifestations. We studied the prevalence of Lyme neuroborreliosis in patients with stroke. METHODS: During a 1-year period, sera from patients with cerebral thrombosis or transient ischemic attack without cardioembolism were investigated for antibodies against B burgdorferi. RESULTS: One of 281 patients had a positive serum immunoglobulin M titer and 23 of 281 (8%) had positive serum immunoglobulin G titers against B burgdorferi. One of the 24 seropositive patients, with a diagnosis of transient ischemic attack due to dysphasia, had a lymphocytic pleocytosis and intrathecal antibody production against B burgdorferi. The medical history revealed a 9-month period of general and neurological symptoms compatible with Lyme neuroborreliosis before the strokelike incidents. CONCLUSIONS: We conclude that Lyme neuroborreliosis may imitate stroke, but screening for antibodies against B burgdorferi seems to be of little value and may be replaced by a careful medical history.
stroke.ahajournals.org/cgi/content/abstract/24/9/1393______________________________________________________
Arch Pediatr. 1999 Dec;6(12):1302-5.
[
Ischemic stroke caused by neuroborreliosis]
[Article in French]
Laroche C, Lienhardt A, Boulesteix J.
Service de pédiatrie II, CHU Dupuytren, Limoges, France.
Ischemic stroke in children is rare and its etiology is frequently unknown. CASE REPORT: We report the case of a nine-year-old boy who presented a right ischemic lenticular stroke due to neuroborreliosis, with a good outcome after antibiotic treatment. CONCLUSION: We suggest that it is important to search for neuroborreliosis in case of an ischemic stroke in children; the study of cerebral spinal fluid is a good diagnostic marker.
PMID: 10627902 [PubMed - indexed for MEDLINE]
www.ncbi.nlm.nih.gov/pubmed/10627902______________________________________________________
Arch Phys Med Rehabil. 2000 Apr;81(4):519-21.
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]
www.ncbi.nlm.nih.gov/pubmed/10768546______________________________________________________
Rev Neurol (Paris). 1988;144(12):765-75.
[
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.
PMID: 3070690 [PubMed - indexed for MEDLINE]
www.ncbi.nlm.nih.gov/pubmed/3070690
