Lyme Disease, Babesia and Bartonella Cause Heart Attacks and Strokes
Rev Neurol (Paris). 2009 Mar;165(3):273-7. Epub 2008 Aug 28.
[Recurrent ischemic strokes revealing Lyme meningovascularitis]
[Article in French]
Sparsa L, Blanc F, Lauer V, Cretin B, Marescaux C, Wolff V.
D�partement de neurologie, h�pital Civil, h�pitaux universitaires, 1, place de l'H�pital, 6700 Strasbourg, France.
INTRODUCTION: Infectious vascularitis is an unusual cause of ischemic stroke (IS). We report a case of Lyme meningovascularitis complicated with multiple IS. CASE REPORT: A 64-year-old man, without any cardiovascular risk factor, was admitted for a right hemiparesia with a left thalamic hypodensity on the initial cerebral CT scan. No cause for this presumed IS could be identified. Later, the patient developed cognitive impairment and a bilateral cerebellar syndrome. Multiple infarcts and multiple intracranial stenosis were seen on cerebral MRI with magnetic resonance angiography (MRA). Cerebrospinal fluid tests showed meningitis and positive Lyme serology with an intrathecal specific anti-Borrelia antibody index. Antibiotic treatment was followed by good biological and partial clinicoradiological outcome. CONCLUSION: The diagnosis of Lyme neuroborreliosis should be entertained as a possible cause of IS in highly endemic zones.
PMID: 18760428 [PubMed - indexed for MEDLINE]
Med Pregl. 2006 Nov-Dec;59(11-12):577-9.
[An unusual cause of complete atrioventricular block--a case report]
[Article in Serbian]
Krotin M, Milovanovi� B, Vukovi� D, Celeketi� D.
Klinicko-bolnicki centar "Bezanijska Kosa", Beograd.
INTRODUCTION: Complete atrioventricular block is a serious disorder, since patients may be asymptomatic. However, it is an important risk for sudden cardiac death. CASE REPORT: A 48-year old male patient was admitted to the coronary care unit, due to recurring substernal chest pain. It was followed by fatigue, weakness and confusion, it lasted more than half an hour and occurred twice. Loss of consciousness did not occur. The patient had a tick bite two months earlier. Physical examination was unremarkable, except for low heart rate (50/minute) electrocardiogram showed a complete atrioventricular block with narrow QRS complexes and good ventricular function. Elevation of ST segment was observed in the inferior ECG leads, with reciprocal ST depression in precordial leads; it was highly suspicious for acute myocardial infarction, but markers of myocardial necrosis (Troponin, Creatine kinase-MB) were normal. The chest pain recurred without evolutive changes in the electrocardiogram or increase in markers of myocardial necrosis. Tests for Lyme disease were negative, too. The cause of atrioventricular conduction disturbance was found by transthoracic echocardiography. A giant tumor was found in the right atrium and right ventricle. Further examinations excluded its secondary cause and the patient was sent to surgery. The tumor was inoperable and bled excessively. Although permanent pacing was performed, the patient died suddenly after dismisal. CONCLUSION: We can conclude that a giant primary tumor of the heart can be asymptomatic for a long time causing complete atrioventricular block, and in this case it clinically presented as acute myocardial infarction. Echocardiographic examination was the main diagnostic tool in our case.
PMID: 17633901 [PubMed - indexed for MEDLINE]
Med Mal Infect. 2007 Jul-Aug;37(7-8):511-7. Epub 2007 Jul 16.
[Cardiac involvement in Lyme disease]
[Article in French]
Service de cardiologie, CHU, place Henri-Dunant, 63000 Clermont-Ferrand, France. email@example.com
Cardiac manifestations of Lyme Borreliosis are relatively infrequent, occurring within weeks after the infectious tick bite (median of 21 days), and resulting at this stage from a direct borrelial infection of the myocardium, as indicated by reports of spirochete isolation from pericardium and myocardium. They may persist or appear in the late, tertiary phase of the illness, being then more likely due to infection-triggered autoimmunity. Lyme carditis typically presents with a fluctuating degree of atrioventricular block that spontaneously resolves in several days. Rarely, myocarditis may occur with or without pericardial involvement, in patients presenting with chest pain, ST depression or T wave inversion, mimicking an acute myocardial infarction, and various arrhythmias are reported, as well as pericardial effusion or heart failure. A complete recovery is usually observed, spontaneous or after antibiotherapy. Severe myocarditis or Pericarditis leading to death is exceptional. The diagnosis of Lyme carditis is based on the same association of clinical and laboratory features as in Lyme disease without cardiac involvement. But the occurrence of conduction disturbances in healthy young people suggests screening for other criteria of Lyme disease. The management of Lyme carditis does not differ from the treatment of Lyme disease without carditis and is mainly based upon the use of doxycycline or ceftriaxone.
PMID: 17629649 [PubMed - indexed for MEDLINE]
J Neurol Sci. 2007 Jun 15;257(1-2):255-7. Epub 2007 Mar 8.
Cryptogenic multi-infarcts and cortico-subcortical dementia in a young adult.
Guimar�es J, Fonseca R, Azevedo E.
Department of Neurology, Hospital S�o Jo�o, University of Porto, Portugal. firstname.lastname@example.org
INTRODUCTION: Etiology of stroke and dementia in young adults are challenging clinical problems, and these diseases often have devastating consequences. We present a case where a final etiologic diagnosis is not possible, in spite of an exhaustive study. CASE REPORT: A 34-year-old man presented with a 5-year history of transient neurological deficits. Examination disclosed a cortico-subcortical dementia, but no other deficits. Laboratory evaluation was unremarkable, including the basic vascular study, homocystein, immunologic study, ACE, serology for Lyme, syphilis and HIV, tests for mitochondrial cytopathy, CADASIL and Fabry's disease, and CSF study. Prothrombotic study was normal except for a heterozygous mutation for factor V Leiden and for methylene tetrahydrofolate reductase. Cardiac exams (electrocardiogram, transesophagic echocardiography and 24 h-ECG) were normal. Cervical and transcranial duplex ultrasound and magnetic resonance angiography (MRA)-were normal, except for a hypoplasic right vertebral artery. Brain magnetic resonance imaging revealed corticosubcortical atrophy and multiple infarcts. The patient was prescribed antiplatelet and statin therapy, and is presently clinically stabilized after 3 years of follow-up, scoring 2 in modified Rankin scale. DISCUSSION: Differential diagnosis of young onset vascular dementia is wide, including a number of rare sporadic and hereditary diseases. Although our case has a heterozygotic mutation for factor V Leiden, this might not explain the whole clinical picture; furthermore, there is no history of other vascular events, as venous thrombosis. An extensive investigation did not lead to a final etiological diagnosis. Nevertheless, even in these cases prevention with antiplatelet and statin might lead to clinical stabilization.
PMID: 17349661 [PubMed - indexed for MEDLINE]
Cerebrovasc Dis. 2004;17(1):79-81. Epub 2003 Oct 6.
Cerebral vasculitis with multiple infarcts caused by lyme disease.
Schmiedel J, Gahn G, von Kummer R, Reichmann H.
Department of Neurology, Carl Gustav Carus University of Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany. Janet.Schmiedel@t-online.de
PMID: 14534380 [PubMed - indexed for MEDLINE]
Eur Neurol. 2003;50(2):109-12.
Cerebral vasculitis as the only manifestation of Borrelia burgdorferi infection in a 17-year-old patient with basal ganglia infarction.
Heinrich A, Khaw AV, Ahrens N, Kirsch M, Dressel A.
Department of Neurology, University of Greifswald, Greifswald, Germany. email@example.com
PMID: 12944718 [PubMed - indexed for MEDLINE]
Zh Nevrol Psikhiatr Im S S Korsakova. 2003;103(7):62-6.
[Clinical thinking in neurological diagnosis (French experience)]
[Article in Russian]
Akhvlediani R, Mogilevskii� A, Kontan S.
PMID: 12938658 [PubMed - indexed for MEDLINE]
Z Kardiol. 2002 Dec;91(12):1053-60.
[The Lyme carditis as a rare differential diagnosis to an anterior myocardial infarction]
[Article in German]
Dernedde S, Piper C, K�hl U, Kandolf R, Mellwig KP, Schmidt HK, Horstkotte D.
Kardiologische Klinik, Herzzentrum Nordrhein-Westfalen Ruhr-Universit�t Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.
An acute Lyme carditis affects about 0.3-4% of patients with Lyme borreliosis. The acute period of the disease may be associated with critical atrioventricular conduction abnormalities (complete heart block), supraventricular and ventricular arrhythmias as well a left ventricular failure. Normally, Lyme carditis is completely reversible. Therefore the prognosis largely depends on the management of the acute complications and early antibiotic therapy. Even if the symptoms are spontaneously reversible, antibiotic therapy should be applied to prevent a chronic cardiomyopathy and other manifestations of Lyme borreliosis. We report on a 47-year old patient with acute ECG changes initially suggesting an acute coronary syndrome. However, case history and the erythema migrans indicated an acute Lyme carditis which was confirmed serologically and by myocardial biopsy later.
PMID: 12490995 [PubMed - indexed for MEDLINE]
Arch Mal Coeur Vaiss. 2001 Dec;94(12):1419-22.
[Lyme disease presenting as infarction pain. A case report]
[Article in French]
Meimoun P, Sayah S, Benali T, Bore AL, Bailly J, Beausoleil J, Jeleff C, Maitre B.
Service de cardiologie et de soins intensifs, �entre hospitalier de Compi�gne, 8, avenue Henry Adnot, 60321 Compi�gne.
Lyme's disease is a multi-system condition due to infection with a spirochete (Borrelia Burgdorferi), transmitted by a tick. Cardiac involvement, which is not systematic, usually presents with transient atrioventricular block of varying degree. The authors describe an unusual presentation of the cardiac involvement of Lyme's disease with chest pain resembling an acute coronary syndrome in a 32 year old man. The characteristic skin lesion (erythema migrans), the positivity of IgM serology, the myocardial scintigraphic results and the negativity of the work-up of other causes of this pain led to a diagnosis of myocarditis, the outcome of which was favourable with treatment by amoxycillin (3 g/day, orally).
PMID: 11828929 [PubMed - indexed for MEDLINE]
Differential diagnosis of posterior fossa multiple sclerosis lesions--neuroradiological aspects.
Falini A, Kesavadas C, Pontesilli S, Rovaris M, Scotti G.
Department of Neuroradiology, Scientific Institute San Raffaele Hospital, Milan, Italy.
Various infratentorial pathological conditions can mimic multiple sclerosis (MS) both clinically and radiologically. We review the inflammatory, vascular, neoplastic and metabolic conditions which show features similar to those of MS on magnetic resonance imaging (MRI). Behcet's disease, Lyme disease, progressive multifocal leukoencephalopathy, neurosarcoidosis, Whipple's disease, listeria rhombencephalitis, Bickerstaff's brainstem encephalitis, vasculitis due to systemic lupus erythematosus, and acute disseminated encephalomyelitis produce inflammatory lesions similar to those of MS in the brainstem and cerebellum. Neoplastic diseases, in particular pontine gliomas and lymphomas, can mimic MS. Vascular ischaemic lesions, either due to infarction produced by occlusion of a major posterior circulation artery or due to small vessel vasculopathy, can lead to posterior fossa lesions. The MRI changes of central pontine myelinolysis can also mimic MS. Diffuse axonal injury, radiation and chemotherapy induce lesions that resemble MS, however the clinical history will exclude these possibilities. Finally, we discuss a few conditions which are similar to MS in clinical presentation but have different MRI appearances, such as brainstem cavernomas, posterior fossa tumoural lesions, aneurysms and vascular loops producing neurovascular conflicts. Analysis of the MRI findings with clinical history and laboratory data helps to narrow down the diagnosis of the infratentorial pathology.
PMID: 11794484 [PubMed - indexed for MEDLINE]
Rev Neurol (Paris). 2000 Dec;156(12):1154-6.
[Left sided sudden hemiparesis linked to a central form of Lyme disease]
[Article in French]
Deloizy M, Devos P, Stekelorom T, Testard D, Belhadia A.
Service de Neurologie, Centre Hospitalier de Boulogne S/Mer.
Lyme disease is known for its numerous neurological manifestations. Cerebral ischemic lesions are more rarely reported. We describe the case of a 27 - year old man - presenting with a left-sided hemiparesis when waking up. We first thought of a stroke, due to the presence of a light right capsulo-thalamic hypodensity on C.T. scan and the spontaneous regression of the hemiparesis within a few days. However, the lumbar puncture performed on the patient due to a fever running 38 degrees C and some drowziness showed a lymphocytic pleocytosis with a very inflammatory face of the spinal fluid. The M. R.I. revealed a right capsular and thalamic image with edema of the front part of the thalamus showing either a vascular or an inflammatory origin. The Lyme serodiagnosis in the blood and in the spinal fluid was positive, and we demonstrated an intrathecal Borrelia burgdorferi specific antibody synthesis. This case is interesting because it shows a central form of neuroborreliosis through cerebral infarct and its regressive evolution under treatment. The possible pathophysiology mechanisms have been discussed.
PMID: 11139733 [PubMed - indexed for MEDLINE]
Schweiz Med Wochenschr. 2000 Sep 9;130(36):1265-71.
[Diagnosis and course of myocarditis: a survey in the medical clinics of Zurich University Hospital 1980 to 1998]
[Article in German]
Sauvant G, Bossart W, Kurrer MO, Follath F.
Departement f�r Innere Medizin, Universit�tsspital Z�rich.
The clinical picture of myocarditis/myopericarditis is of importance in differential diagnosis, especially in younger patients with suspected myocardial infarction. Myocarditis/myopericarditis commonly presents with chest pain, and the diagnosis is usually established on clinical grounds. However, endomyocardial biopsy is necessary to confirm the diagnosis. We evaluated the characteristics of acute myocarditis over the years 1980-1998 in 54 patients of the Department of Medicine of the University Hospital, Zurich. Two to 6 patients per year were hospitalised with this diagnosis. In most cases the diagnosis was established by a combination of criteria, such as a preceding infection of the upper respiratory tract, thoracic pain, ST segment elevations in different precordial leads followed by T wave inversions, arrhythmias, elevation of cardiac enzymes, reversible hypokinesia by echocardiography and normal coronary arteries. At least 3 of 5 criteria were requested. In a first step we analysed retrospectively all patients with acute myocarditis/myopericarditis in the years 1980-1993. Among 30 cases of acute myocarditis/myopericarditis the following causes could be identified: one influenza B, one Toxoplasma gondii infection, 2 Epstein-Barr infections and one bacterial myocarditis with gram-negative rods. The aetiology of the other 25 cases remained unknown. The majority of myocarditis/myopericarditis healed without complications. One patient with Epstein-Barr myocarditis and one with Toxoplasma gondii infection died. Two patients developed dilated cardiomyopathy. In a second phase we analysed prospectively all cases with acute myocarditis/myopericarditis over the period 1994-1998: 24 patients with acute myocarditis/myopericarditis were hospitalised. At that time coronary angiography and endomyocardial biopsies were performed more frequently. We found 2 patients with giant cell myocarditis and 2 with Toxoplasma gondii infection and HIV, all of whom died. In addition, there were 2 patients with eosinophilic myocarditis, one with Lyme carditis, one with Epstein-Barr myocarditis, one with myopericarditis after Campylobacter enteritis and one histologically proven myocarditis after pneumonia with Haemophilus influenzae. The aetiology of the remaining 13 cases with myocarditis/myopericarditis could not be established. Three patients with probable viral myocarditis developed cardiogenic shock requiring intraaortic balloon pump, and fully recovered. The patient with Lyme carditis manifested with total atrioventricular block and was treated with a temporary pacemaker. One patient with lymphocytic myocarditis required heart transplantation because of terminal heart failure and one female patient with histologically proven diffuse lympho-monocytic myocarditis died of cardiogenic shock. All the other cases healed without complications. Serologies are of little diagnostic value and should be restricted to serologies with therapeutic implications. We believe that the apparent increase in myocarditis/myopericarditis in recent years is a result of better diagnostic tools, such as more specific cardiac enzyme tests, coronary angiography and endomyocardial biopsies. In most cases the therapy remains symptomatic. In elected, severe cases steroids and other immunosuppressive drugs are sometimes used.
PMID: 11028270 [PubMed - indexed for MEDLINE]
Arch Dis Child. 2000 Jul;83(1):67-71.
Primarily chronic and cerebrovascular course of Lyme neuroborreliosis: case reports and literature review.
Wilke M, Eiffert H, Christen HJ, Hanefeld F.
Kinderklinik der Georg-August- Universitat, Abteilung Kinderheilkunde, Schwerpunkt Neuropadiatrie, Robert-Koch-Strabetae 40, 37075 Gottingen, Germany.
As part of an ongoing study aiming to define the clinical spectrum of neuroborreliosis in childhood, we have identified four patients with unusual clinical manifestations. Two patients suffered from a primarily chronic form of neuroborreliosis and displayed only non-specific symptoms. An 11 year old boy presented with long standing symptoms of severe weight loss and chronic headache, while the other patient had pre-existing mental and motor retardation and developed seizures and failure to thrive. Two further children who presented with acute hemiparesis as a result of cerebral ischaemic infarction had a cerebrovascular course of neuroborreliosis. One was a 15 year old girl; the other, a 5 year old boy, is to our knowledge the youngest patient described with this course of illness. Following adequate antibiotic treatment, all patients showed substantial improvement of their respective symptoms. Laboratory and magnetic resonance imaging findings as well as clinical course are discussed and the relevant literature is reviewed.
PMCID: PMC1718399 PMID: 10869004 [PubMed - indexed for MEDLINE]
Nervenarzt. 1999 Feb;70(2):167-71.
[Neuroborreliosis with extensive cerebral vasculitis and multiple cerebral infarcts]
[Article in German]
Schmitt AB, K�ker W, Nacimiento W.
Neurologische Klinik, Medizinische Einrichtungen der RWTH, Aachen.
We report on a patient who suffered from borreliosis-induced severe cerebral vasculitis accompanied by multiple cerebral infarctions leading to hemiparesis, hemianopsia and reduced consciousness. Despite antibiotic and immunosuppressive therapy with ceftriaxon and prednisolone the patients condition deteriorated. Cerebral angiography showed multiple stenoses of large arteries of the posterior circulation and ubiquitous irregularities of small vessel wails. General reduced perfusion reflected an increased peripheral resistance. After 4 weeks of additional immunosuppressive treatment with cyclophosphamide the neurological status and angiographic findings improved dramatically.
PMID: 10098153 [PubMed - indexed for MEDLINE]
Lancet. 1997 Nov 15;350(9089):1447-8.
Borrelia burgdorferi infection in patients with suspected acute myocardial infarction.
Oksi J, Voipio-Pulkki LM, Uksila J, Pulkki K, Laippala P, Viljanen MK.
PMID: 9371173 [PubMed - indexed for MEDLINE]
Ugeskr Laeger. 1997 May 19;159(21):3175-7.
[Lyme neuro-borreliosis in a 66-year old women. Differential diagnosis of cerebral metastases and cerebral infarction]
[Article in Danish]
Odder Centralsygehus, medicinsk afdeling.
A 66-year-old woman with medically treated hypertension and a recent operation for breast cancer was admitted because of burning pain localized between her shoulder blades and a paretic, dysaesthetic right arm. CSF examination revealed lymphocytic pleocytosis and specific IgM Borrelia burgdorferi antibodies. CT was normal. The patient was treated intravenously with high doses of penicillin for 14 days, and within one month of admission she had recovered completely neurologically. During the first days of treatment a drop in blood pressure, ECG changes, and further neurological changes were observed, but disappeared spontaneously within three days. The patient did not recall a tick bite, and the case illustrates that neuroborreliosis may be a differential diagnosis to stroke or cerebral neoplasms in elderly patients.
PMID: 9199007 [PubMed - indexed for MEDLINE]
Infection. 1996 Jan-Feb;24(1):88-90.
Ceftriaxone in the treatment of Lyme neuroborreliosis.
Roh�cov� H, Hancil J, Hulinsk� D, Mailer H, Havl�k J.
Hospital of Infectious Diseases, Charles University, Prague, Czech Republic.
In an open non-comparative clinical trial with the aim of evaluating the clinical efficacy and safety of a 14 day course of 2 g ceftriaxone once daily, 46 patients with neuroborreliosis were entered at the Infectious Diseases Teaching Hospital in Prague 8. In 39 patients the diagnosis was early Lyme neuroborreliosis. Seven patients suffered from late stage disease. Clinical results were 30% of patients cured at the end of treatment and 85% after 9 months in early stage disease. In late stage disease two patients out of seven were cured and four had improved after 12 months. One patient died because of cardiac infarction. In no patient had treatment to be discontinued because of adverse reactions to antibiotics.
PMID: 8852479 [PubMed - indexed for MEDLINE]
Arch Dermatol. 1993 Jun;129(6):709-16.
Primary and secondary erythema migrans in central Wisconsin.
Melski JW, Reed KD, Mitchell PD, Barth GD.
Department of Dermatology, Marshfield Clinic, WI 54449.
BACKGROUND AND DESIGN: We report a series of 28 consecutive patients with erythema migrans (EM) who underwent skin biopsies for culture of Borrelia burgdorferi. Culture results, Lyme serologic findings, and clinical features in patients with only primary EM are compared with those in patients with secondary EM. RESULTS: Culture preparations of skin specimens obtained from six of 12 patients with only primary EM, and from 14 of 16 patients with secondary EM were positive for B burgdorferi. Seven patients with only primary EM were initially seronegative, and only one patient had an annular lesion. A central crusted punctum was present in five of six primary EM lesions that were not culture positive, but in none of nine culture-positive primary EM lesions. Patients with secondary EM were all seropositive and had less cutaneous and more constitutional symptoms than patients with only primary EM. Three patients with secondary EM had abnormal liver enzyme profiles, one patient had complete heart block, and one patient had myocarditis simulating infarction. Less than one third of all patients recalled a tick bite. An isomorphic nonresponse was seen in skin previously involved with secondary EM in one patient who had a drug exanthem from amoxicillin. CONCLUSIONS: Borrelia burgdorferi can be reliably cultured from skin biopsy specimens of secondary EM. Culture preparation aids definitive diagnosis of Lyme disease in patients with only primary EM who often lack constitutional symptoms, have nondiagnostic lesions, or are seronegative.
PMID: 8389536 [PubMed - indexed for MEDLINE]
Lyme disease presenting as a stroke in the vertebrobasilar territory: MRI.
Defer G, Levy R, Brugi�res P, Postic D, Degos JD.
D�partement de Neurosciences, CHU Henri Mondor, Cr�teil, France.
A 28-year-old female farmer, without vascular risk factors, developed a limited infarct of the pons, associated with a lymphocytic cerebrospinal fluid (CSF) pleocytosis. Titres of specific antibodies against Borrelia burgdorferi were high in serum and CSF. MRI confirmed an infarct in the territory of the medial pontine arteries, but angiography showed no evidence of cerebral angiopathy. Antibiotic therapy rapidly led to a return to normal of CSF cytology and serology. We suggest that Lyme disease is a possible cause of cerebral ischaemia.
PMID: 8232882 [PubMed - indexed for MEDLINE]
Am J Med. 1992 Sep;93(3):352-3.
Not everything that glitters is Lyme disease.
Miralles D, Hartman B, Brause B, Fisher L, Murray HW.
Cornell University Medical College, New York, New York.
PMID: 1524093 [PubMed - indexed for MEDLINE]
Ann Emerg Med. 1990 May;19(5):572-6.
The enlarging clinical spectrum of Lyme disease: Lyme cerebral vasculitis, a new disease entity.
Brogan GX, Homan CS, Viccellio P.
School of Medicine, SUNY/Stony Brook 11794-7400.
Comment in: Ann Emerg Med. 1990 Nov;19(11):1353-4.
The case of a patient with cerebral vasculitis with a right thalamic infarct associated with cerebral spinal fluid Lyme disease is presented. This entity has not been described in the United States, and only one similar case in the world literature could be found. The patient presented with a progressive headache and subsequent development of grand mal seizure activity. Lyme disease has been associated with cranial nerve palsies, peripheral and cranial radiculopathies, aseptic meningitis, encephalitic symptoms, chorea, and demyelinating polyneuropathy presenting like Guillain-Barr� syndrome. These syndromes can occur separately or in combination. Stroke and strokelike syndromes have been attributed to Lyme disease. The literature concerning the neurologic manifestations of Lyme disease is reviewed.
PMID: 2331105 [PubMed - indexed for MEDLINE]
J Neurol. 1989 Jul;236(5):305-6.
Locked-in state in Borrelia burgdorferi meningitis.
Merlo A, Weder B, Ketz E, Matter L.
Department of Neurology, Kantonsspital, St. Gallen, Switzerland.
The case is reported of a 28-year-old woman with persistent tetraplegia following acute meningitis due to Borrelia burgdorferi infection. The patient developed erythema chronicum migrans before radicular pain occurred in the upper extremities. The poor clinical outcome was suggestive of pontine infarction due to vasculitis of branches of the basilar artery.
PMID: 2760649 [PubMed - indexed for MEDLINE]
J Neurol. 1987 Jan;234(1):40-3.
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]
Acta Neurol Scand Suppl. 1986;104:1-109.
Immunoglobulin producing cells in nervous system diseases.
PMID: 3515827 [PubMed - indexed for MEDLINE]