Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization

Abstract

BackgroundNeuroborreliosis represents a relevant infectious disease and can cause a variety of neurological manifestations. Different stages and syndromes are described and atypical symptoms can result in diagnostic delay or misdiagnosis. The aim of this retrospective study was to define the pivotal neurological deficits in patients with neuroborreliosis that were the reason for admission in a hospital.MethodsWe retrospectively evaluated data of patients with neuroborreliosis. Only patients who fulfilled the diagnostic criteria of an intrathecal antibody production against Borrelia burgdorferi were included in the study.ResultsSixty-eight patients were identified with neuroborreliosis. Cranial nerve palsy was the most frequent deficit (50%) which caused admission to a hospital followed by painful radiculitis (25%), encephalitis (12%), myelitis (7%), and meningitis/headache (6%). In patients with a combination of deficits, back pain was the first symptom, followed by headache, and finally by cranial nerve palsy. Indeed, signs of meningitis were often found in patients with neuroborreliosis, but usually did not cause admission to a hospital. Unusual cases included patients with sudden onset paresis that were initially misdiagnosed as stroke and one patient with acute delirium. Cerebrospinal fluid (CSF) analysis revealed typical changes including elevated CSF cell count in all but one patient, a blood-CSF barrier dysfunction (87%), CSF oligoclonal bands (90%), and quantitative intrathecal synthesis of immunoglobulins (IgM in 74%, IgG in 47%, and IgA in 32% patients). Importantly, 6% of patients did not show Borrelia specific antibodies in the blood.ConclusionIn conclusion, the majority of patients presented with typical neurological deficits. However, unusual cases such as acute delirium indicate that neuroborreliosis has to be considered in a wide spectrum of neurological diseases. CSF analysis is essential for a reliable diagnosis of neuroborreliosis.

Secondary dementia due to Lyme neuroborreliosis

“…Of these 10 patients 2 with additional HIV positivity [9] and 1 patient with progressive supranuclear paralysis were excluded [10]. Cases which did not fulfil EFNS guidelines for definitive LNB [2, 11, 12], cases with definitive LNB and dementia, that did not present enough data for the individual patient [13, 59] and cases with cognitive impairment of less than 2 months duration [14, 15] were not included. Using diagnostic guidelines valid for European LNB our review was restricted to European cases with LNB.…”

Chemokine Ligand 13 (CXCL13) in Neuroborreliosis and Neurosyphilis as Selected Spirochetal Neurological Diseases: A Review of Its Diagnostic Significance

“…If the ELISA test is positive or inconclusive, a Western blot test should be performed to confirm the reaction with spirochetes. Additionally, a CSF analysis indicates mononuclear pleocytosis and the presence of lymphocytes and monocytes in the smear [29,62,63]. It is also important to understand the difference between diagnoses of definite and possible Lyme neuroborreliosis.…”

Clinical Reasoning: A 58-year-old woman presents with progressive memory deficits, odd behavior, and falls

“…3 Her examination and imaging were consistent with Lyme radiculitis and cranial neuropathies that are common manifestations of neuroborreliosis. 4 Lyme involvement of the parenchymal CNS is rare and tends to respond rapidly to antibiotics. 3 Months after appropriate treatment of the patient's hyponatremia and neuroborreliosis, she continued to have cognitive and behavioral abnormalities consistent with a behavioral variant FTD (bvFTD) syndrome.…”