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Palmer KN, Sokola M, Uysal SP, Cooperrider J, Leung AK, Torres-Trejo A, Li Y, Abbatemarco JR. Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series. Neurohospitalist 2024; 14:301-307. [PMID: 38895010 PMCID: PMC11181985 DOI: 10.1177/19418744241246308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Lyme disease is a multisystem disorder transmitted through the Ixodes tick and is most commonly diagnosed in northeastern and mid-Atlantic states, Wisconsin, and Minnesota, though its disease borders are expanding in the setting of climate change. Approximately 10%-15% of untreated Lyme disease cases will develop neurologic manifestations of Lyme neuroborreliosis (LNB). Due to varying presentations, LNB presents diagnostic challenges and is associated with a delay to treatment. We discuss three cases of LNB admitted to our referral center in a traditionally low-incidence state to highlight clinical pearls in LNB diagnosis. Three patients from low-incidence areas with prior diagnostic evaluations presented in August with neurologic manifestations of radiculoneuritis, cranial neuropathies, and/or lymphocytic meningitis. MRI findings included cranial nerve, nerve root, and leptomeningeal enhancement leading to broad differential diagnoses. Lumbar puncture demonstrated lymphocytic pleocytosis (range 85-753 cells/uL) and elevated protein (87-318 mg/dL). Each patient tested positive for Lyme on two-tiered serum testing and was diagnosed with LNB. All three cases were associated with a delay to health care presentation (mean 20 days) and a delay to diagnosis and treatment (mean 54 days) due to under-recognition and ongoing evaluation. With the geographic expansion of Lyme disease, increasing awareness of LNB manifestations and acquiring detailed travel histories in low-incidence areas is crucial to prompt delivery of care. Clinicians should be aware of two-tiered serum diagnostic requirements and use adjunctive studies such as lumbar puncture and MRI to eliminate other diagnoses. Treatment with an appropriate course of antibiotics leads to robust improvement in neurological symptoms.
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Affiliation(s)
| | - Maria Sokola
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Sanem P. Uysal
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Anthony K. Leung
- Department of Infectious Disease, Cleveland Clinic Akron General, Akron, OH, USA
| | - Alejandro Torres-Trejo
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Yuebing Li
- Neuromuscular Center, Cleveland Clinic, Cleveland, OH, USA
| | - Justin R. Abbatemarco
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
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Palackdkharry CS, Wottrich S, Dienes E, Bydon M, Steinmetz MP, Traynelis VC. The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis). PLoS One 2022; 17:e0274634. [PMID: 36178925 PMCID: PMC9524710 DOI: 10.1371/journal.pone.0274634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND & IMPORTANCE This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare "iatrogenic chronic meningitis" causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. METHODS The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. RESULTS Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. DISCUSSION & CONCLUSION DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.
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Affiliation(s)
| | - Stephanie Wottrich
- Case Western Reserve School of Medicine, Cleveland, Ohio, United States of America
| | - Erin Dienes
- Arcsology®, Mead, Colorado, United States of America
| | - Mohamad Bydon
- Department of Neurologic Surgery, Orthopedic Surgery, and Health Services Research, Mayo Clinic School of Medicine, Rochester, Minnesota, United States of America
| | - Michael P. Steinmetz
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine Neurologic Institute, Cleveland, Ohio, United States of America
| | - Vincent C. Traynelis
- Department of Neurosurgery, Rush University School of Medicine, Chicago, Illinois, United States of America
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3
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Winn A, Martin A, Castellon I, Sanchez A, Lavi ES, Munera F, Nunez D. Spine MRI: A Review of Commonly Encountered Emergent Conditions. Top Magn Reson Imaging 2021; 29:291-320. [PMID: 33264271 DOI: 10.1097/rmr.0000000000000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the last 2 decades, the proliferation of magnetic resonance imaging (MRI) availability and continuous improvements in acquisition speeds have led to significantly increased MRI utilization across the health care system, and MRI studies are increasingly ordered in the emergent setting. Depending on the clinical presentation, MRI can yield vital diagnostic information not detectable with other imaging modalities. The aim of this text is to report on the up-to-date indications for MRI of the spine in the ED, and review the various MRI appearances of commonly encountered acute spine pathology, including traumatic injuries, acute non traumatic myelopathy, infection, neoplasia, degenerative disc disease, and postoperative complications. Imaging review will focus on the aspects of the disease process that are not readily resolved with other modalities.
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Affiliation(s)
- Aaron Winn
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Adam Martin
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Ivan Castellon
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Allen Sanchez
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | | | - Felipe Munera
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Diego Nunez
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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4
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Ørbæk M, Klausen C, Lebech AM, Mens H. Lyme Neuroborreliosis in a Patient with Breast Cancer: MRI and PET/CT Findings. Diagnostics (Basel) 2020; 10:diagnostics10010036. [PMID: 31936608 PMCID: PMC7169463 DOI: 10.3390/diagnostics10010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 11/16/2022] Open
Abstract
We present a case demonstrating the performance of different radiographical and nuclear medicine imaging modalities in the diagnostic work-up of a patient with Lyme neuroborreliosis. The patient presented in late summer 2019 with radicular pains followed by a foot drop and peripheral facial palsy, both right-sided. Due to a history of breast cancer, disseminated malignant disease was initially suspected. Bone metastasis was ruled out by skeletal scintigraphy. Magnetic resonance imaging (MRI) of the neuroaxis and a whole body 18F-FDG PET-CT was performed within 48 hours. The MRI revealed a strong contrast enhancement of the conus medullaris and fibers of the cauda equina, while the 18F-FDG PET/CT was without pathological findings. Examination of cerebrospinal fluid led to the definitive diagnosis of Lyme neuroborreliosis with monocytic pleocytosis and a positive intrathecal test for Borrelia burgdorferi. The patient became pain-free after 10 days of ceftriaxone, and the paralysis slowly regressed the following month. This case highlights the difficulty of the diagnosis of Lyme neuroborreliosis and discusses the relevant imaging findings.
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Affiliation(s)
- Mathilde Ørbæk
- Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark (H.M.)
- Correspondence: ; Tel.: +45-35451498
| | - Camilla Klausen
- Department of Radiology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark;
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark (H.M.)
| | - Helene Mens
- Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark (H.M.)
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Valand HA, Goyal A, Melendez DA, Matharu SS, Mangat HS, Tu RK. Lyme Disease: What the Neuroradiologist Needs to Know. AJNR Am J Neuroradiol 2019; 40:1998-2000. [PMID: 31672835 DOI: 10.3174/ajnr.a6301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 11/07/2022]
Abstract
Lyme disease is the most common tick-borne disease in Canada and the United States, caused by Borrelia burgdorferi, which affects multiple organ systems. Epidemiology, clinical presentation, and neuroimaging findings are reviewed.
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Affiliation(s)
- H A Valand
- From the American University of Integrative Sciences (H.A.V.), Brampton, Ontario, Canada
| | - A Goyal
- George Washington University (A.G., D.A.M.), Washington, DC
| | - D A Melendez
- George Washington University (A.G., D.A.M.), Washington, DC
| | - S S Matharu
- The Fischell Department of Bioengineering (S.S.M.), University of Maryland College Park, College Park, Maryland
| | - H S Mangat
- Germantown Medical Center (H.S.M.), Germantown, Maryland
| | - R K Tu
- Progressive Radiology (R.K.T.), George Washington University, United Medical Center, Washington, DC.
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Imaging in Lyme neuroborreliosis. Insights Imaging 2018; 9:833-844. [PMID: 30187265 PMCID: PMC6206375 DOI: 10.1007/s13244-018-0646-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/25/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract Lyme neuroborreliosis (LNB) is a tick-borne spirochetal infection with a broad spectrum of imaging pathology. For individuals who live in or have travelled to areas where ticks reside, LNB should be considered among differential diagnoses when clinical manifestations from the nervous system occur. Radiculitis, meningitis and facial palsy are commonly encountered, while peripheral neuropathy, myelitis, meningoencephalitis and cerebral vasculitis are rarer manifestations of LNB. Cerebrospinal fluid (CSF) analysis and serology are key investigations in patient workup. The primary role of imaging is to rule out other reasons for the neurological symptoms. It is therefore important to know the diversity of possible imaging findings from the infection itself. There may be no imaging abnormality, or findings suggestive of neuritis, meningitis, myelitis, encephalitis or vasculitis. White matter lesions are not a prominent feature of LNB. Insight into LNB clinical presentation, laboratory test methods and spectrum of imaging pathology will aid in the multidisciplinary interaction that often is imperative to achieve an efficient patient workup and arrive at a correct diagnosis. This article can educate those engaged in imaging of the nervous system and serve as a comprehensive tool in clinical cases. Key Points • Diagnostic criteria for LNB emphasise exclusion of an alternative cause to the clinical symptoms. • MRI makes a crucial contribution in the diagnosis and follow-up of LNB. • MRI may have normal findings, or show neuritis, meningitis, myelitis, encephalitis or vasculitis. • White matter lesions are not a prominent feature of LNB.
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Morales H, Betts A. Abnormal Spinal Cord Magnetic Resonance Signal: Approach to the Differential Diagnosis. Semin Ultrasound CT MR 2016; 37:372-83. [PMID: 27616311 DOI: 10.1053/j.sult.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
T2-hyperintense signal abnormalities within the spinal cord on magnetic resonance imaging can evoke a broad differential diagnosis and can present a diagnostic dilemma. Here, we review and provide a succinct and relevant differential diagnosis based on imaging patterns and anatomical or physiopathologic correlation. Clues and imaging pearls are provided focusing on inflammatory, infectious, demyelinating, vascular, and metabolic involvement of the spinal cord.
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Affiliation(s)
- Humberto Morales
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH.
| | - Aaron Betts
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH
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Abstract
The imaging features of spinal parasitic diseases and other rare infections are herein discussed. These diseases are distributed worldwide, with increased prevalence in areas with poor sanitary conditions and in developing countries. In nonendemic areas, sporadic cases may occur, consequent to increased international travel and immunocompromising conditions. Infectious diseases are usually treatable, and early detection is often crucial. A thorough comprehension of the imaging patterns associated with the clinical features, epidemiology, and laboratory results allows the radiologist to narrow down the options for differential diagnosis and facilitates the timely implementation of appropriate therapies.
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Affiliation(s)
- Lázaro Luís Faria do Amaral
- Division of Neuroradiology, Santa Casa de Misericórdia de São Paulo, Rua Cesário Motta Júnior, 112, Vila Buarque, São Paulo, São Paulo 01221-020, Brazil; Division of Neuroradiology, MEDIMAGEM - Hospital da Beneficência Portuguesa de São Paulo, Rua Luiz Gottschalk, 151, Apartment 111 MS, Vila Mariana, São Paulo, São Paulo 04008-070, Brazil.
| | - Renato Hoffmann Nunes
- Division of Neuroradiology, Santa Casa de Misericórdia de São Paulo, Rua Cesário Motta Júnior, 112, Vila Buarque, São Paulo, São Paulo 01221-020, Brazil; Division of Neuroradiology, Fleury Medicina e Saúde, Rua Cincinato Braga, 282, Bela Vista, São Paulo, São Paulo 01333-010, Brazil
| | - Antonio Jose da Rocha
- Division of Neuroradiology, Santa Casa de Misericórdia de São Paulo, Rua Cesário Motta Júnior, 112, Vila Buarque, São Paulo, São Paulo 01221-020, Brazil; Division of Neuroradiology, Fleury Medicina e Saúde, Rua Cincinato Braga, 282, Bela Vista, São Paulo, São Paulo 01333-010, Brazil
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9
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Sorte DE, Poretti A, Newsome SD, Boltshauser E, Huisman TAGM, Izbudak I. Longitudinally extensive myelopathy in children. Pediatr Radiol 2015; 45:244-57; quiz 241-3. [PMID: 25636706 DOI: 10.1007/s00247-014-3225-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 08/09/2014] [Accepted: 10/27/2014] [Indexed: 12/13/2022]
Abstract
When children present with acute myelopathy manifested by sensory, motor, or bowel and bladder symptoms, MRI of the neuraxis with contrast agent is the most important imaging study to obtain. Although occasionally normal, MRI often demonstrates signal abnormality within the spinal cord. Classically, longitudinally extensive transverse myelitis (≥3 vertebral bodies in length) has been described with neuromyelitis optica (NMO), but alternative diagnoses should be considered. This pictorial essay reviews the differential diagnoses that may present with longitudinally extensive spinal cord signal abnormalities. Multiple inflammatory, infectious, vascular, metabolic and neurodegenerative etiologies can present with a myelopathy. Thus, radiologists can assist in the diagnosis by familiarizing themselves with the spectrum of diseases in childhood that result in longitudinally extensive signal abnormalities in the absence of trauma.
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Affiliation(s)
- Danielle Eckart Sorte
- Division of Interventional Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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10
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Raibagkar P, Neagu MR, Lyons JL, Klein JP. Imaging in neurologic infections I: bacterial and parasitic diseases. Curr Infect Dis Rep 2014; 16:443. [PMID: 25348741 DOI: 10.1007/s11908-014-0443-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Often presenting as medical emergencies, nervous system infections can be diagnostically challenging. Knowledgeable utilization of neuroimaging modalities and the understanding of characteristic imaging findings facilitate early diagnosis and treatment. In the first part of this two-part review, we address common and unique diagnostic imaging features of bacterial and parasitic nervous system infections.
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Affiliation(s)
- Pooja Raibagkar
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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12
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Inflammatory, vascular, and infectious myelopathies in children. HANDBOOK OF CLINICAL NEUROLOGY 2013; 112:999-1017. [PMID: 23622308 DOI: 10.1016/b978-0-444-52910-7.00020-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Acute nontraumatic myelopathies of childhood include inflammatory, infectious, and vascular etiologies. Inflammatory immune-mediated disorders of the spinal cord can be categorized as idiopathic isolated transverse myelitis, neuromyelitis optica, and multiple sclerosis. In recent years, human T-cell lymphotropic virus type 1, West Nile virus, enterovirus-71, and Lyme disease have been increasingly recognized as infectious etiologies of myelopathy, and poliomyelitis remains an important etiology in world regions where vaccination programs have not been universally available. Vascular etiologies include vasculopathies (systemic lupus erythematosus, small vessel primary angiitis of the central nervous system), arteriovenous malformations, and spinal cord infarction (fibrocartilaginous embolism, diffuse hypoxic ischemia-mediated infarction). Vascular myelopathies are less common than inflammatory and infectious myelopathies, but are more likely to lead to devastating clinical deficits. Current therapeutic strategies include acute anti-inflammatory treatment and rehabilitation. Stem cell transplantation, nerve graft implantation, and stimulation of endogenous repair mechanisms represent promising strategies for spinal cord repair.
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13
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Abstract
Lyme neuroborreliosis (LNB) designates the nervous system disorders caused by the tick-borne spirochete Borrelia burgdorferi (Bb). The clinical syndromes are usually distinct and are classified as early and the rare late or chronic LNB. Early LNB occurs 3-6 weeks after infection most frequently as a lymphocytic meningoradiculoneuritis (LMR). Symptoms are mainly due to a painful sensory radiculitis and a multifocal motor radiculo-neuritis. Fifty percent have cranial nerve involvement predominantly uni- or bilateral facial nerve palsies. Meningitic symptoms occur primarily in children. Nerve biopsies, autopsies, animal models, and nerve conduction studies showed that the pathology is a lymphocytic perineuritis leading to multisegmental axonal injury of nerve roots, spinal ganglia, and distal nerve segments. Due to meningeal and root inflammation cerebrospinal fluid (CSF) shows lymphocytic inflammation. The only evidence that Bb causes peripheral neuropathy without CSF inflammation is seen in patients with acrodermatitis chronica atrophicans (ACA), a chronic dermatoborreliosis. In the rare chronic or late LNB the pathology and thus the clinical presentation is primarily due to chronic meningitis and meningovascular CNS involvement, whereas the peripheral nervous system is not primarily affected. In early and late LNB the diagnosis is based on a characteristic clinical appearance and CSF inflammation with Bb-specific intrathecal antibody production. Both conditions, but not the ACA-associated neuropathy, respond to antibiotic therapy.
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Affiliation(s)
- Klaus Hansen
- Department of Neurology, Rigshospitalet, University Clinic Copenhagen, Denmark.
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15
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Hildenbrand P, Craven DE, Jones R, Nemeskal P. Lyme neuroborreliosis: manifestations of a rapidly emerging zoonosis. AJNR Am J Neuroradiol 2009; 30:1079-87. [PMID: 19346313 DOI: 10.3174/ajnr.a1579] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Lyme disease has a worldwide distribution and is the most common vector-borne disease in the United States. Incidence, clinical manifestations, and presentations vary by geography, season, and recreational habits. Lyme neuroborreliosis (LNB) is neurologic involvement secondary to systemic infection by the spirochete Borrelia burgdorferi in the United States and by Borrelia garinii or Borrelia afzelii species in Europe. Enhanced awareness of the clinical presentation of Lyme disease allows inclusion of LNB in the imaging differential diagnosis of facial neuritis, multiple enhancing cranial nerves, enhancing noncompressive radiculitis, and pediatric leptomeningitis with white matter hyperintensities on MR imaging. The MR imaging white matter appearance of successfully treated LNB and multiple sclerosis display sufficient similarity to suggest a common autoimmune pathogenesis for both. This review highlights differences in the epidemiology, clinical manifestations, diagnosis, and management of Lyme disease in the United States, Europe, and Asia, with an emphasis on neurologic manifestations and neuroimaging.
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Affiliation(s)
- P Hildenbrand
- Department of Radiology, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
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Charles V, Duprez TP, Kabamba B, Ivanoiu A, Sindic CJM. Poliomyelitis-like syndrome with matching magnetic resonance features in a case of Lyme neuroborreliosis. BMJ Case Rep 2009; 2009:bcr07.2008.0527. [PMID: 21686762 DOI: 10.1136/bcr.07.2008.0527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Lyme disease is a multisystemic disorder caused by an epizootic organism of the spirochete group, called Borrelia burgdorferi (Bb), which is transmitted to humans by ticks of the genus Ixodes. Lyme neuroborreliosis may occur during the early dissemination phase, most often as a painful meningo-radiculitis and very rarely as a radiculo-myelitis, whereas encephalomyelitis is observed in the late phase. We report the case of a patient with an early subacute poliomyelitis-like syndrome closely matching the selective involvement of the anterior horns and roots of the cervical spinal cord seen on magnetic resonance (MR) imaging. This condition improved with appropriate antibiotics.
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Affiliation(s)
- V Charles
- Service de Neurologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Charles V, Duprez TP, Kabamba B, Ivanoiu A, Sindic CJM. Poliomyelitis-like syndrome with matching magnetic resonance features in a case of Lyme neuroborreliosis. J Neurol Neurosurg Psychiatry 2007; 78:1160-1. [PMID: 17878200 PMCID: PMC2117552 DOI: 10.1136/jnnp.2007.121103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- V Charles
- Service de Neurologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Affiliation(s)
- Zoran Rumboldt
- Department of Radiology, Medical University of South Carolina, 169 Ashley Avenue, Charleston, SC 29425, USA.
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Blanc F. Aspects neurologiques et psychiatriques au cours de la maladie de Lyme. Med Mal Infect 2007; 37:435-45. [PMID: 17350199 DOI: 10.1016/j.medmal.2006.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 01/15/2006] [Indexed: 10/23/2022]
Abstract
The neurological and psychiatric manifestations of Borrelia burgdorferi sensu lato are so numerous that Borrelia is also called the "new great imitator". Thus knowing about the multiple clinical aspects of neuroborreliosis is necessary for the clinician. We reviewed literature for "classical" neuroborreliosis such as acute meningoradiculitis or chronicle encephalomyelitis, but also for encephalitis, myelitis, polyneuritis, radiculitis and more controversial disorders such as chronic neurological disorders, ischemic and hemorrhagic stroke, and motor neuron disease. We specified every time on which basis each disorder was attributed to Lyme disease, particularly if European or American criteria were met. Every part of the nervous system can be involved: from central to peripheral nervous system, and even muscles. In endemic areas, Lyme serology must be assessed in case of unexplained neurological or psychiatric disorder. In case of positive serology, CSF assessment with intrathecal anti-Borrelia antibody index will be more efficient to prove the diagnosis.
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Affiliation(s)
- F Blanc
- Département de neurologie, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
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Borreliosi di Lyme e neuroborreliosi. Neurologia 2007. [DOI: 10.1016/s1634-7072(07)70543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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