Chronic progressive neurological involvement in Borrelia burgdorferi infection

Abstract

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.

Secondary dementia due to Lyme neuroborreliosis

“…When patients did remember, chronic progressive encephalomyelitis followed 2 months to 2 years later [22, 23]. Thus, EM or other characteristic symptoms of early LB 1–2 years before the onset of dementia may if untreated serve as an indicator for chronic LNB.…”

Chronic or Late Lyme Neuroborreliosis: Analysis of Evidence Compared to Chronic or Late Neurosyphilis

“…It is also noteworthy, that regressive evolution of cerebral infarct in meningovascular Lyme neuroborreliosis and improvement or disappearance of neuropsychiatric symptoms in Lyme encephalitis following antibiotic treatment were reported by many authors [42, 52, 53, 59, 82, 85, 89, 90, 102, 113-115, 120, 122, 128, 140-142, 158, 159]. …”

Persistent intrathecal secretion of oligoclonal, Borrelia burgdorferi-specific IgG in chronic meningoradiculomyelitis

“…Characteristic cerebrospinal fluid (CSF) findings are lymphocyte and monocyte pleocytosis, increased total protein and immunoglobulins. Investigations of CSF immunoglobulins during different stages consistently show the restricted heterogeneity of CSF IgG by the presence of oligoclonal bands [8,11,24]. The diagnosis is confirmed by high titres of serum and CSF antibodies, specific for Borrelia burgdorferi, which has recently been identified as the aetiological agent of Lyme disease and Bannwarth's syndrome [2].…”