Inflammatory brain changes in Lyme borreliosis

Abstract

Despite a rapid increase in the number of patients with Lyme neuroborreliosis (LNB), its neuropathological aspects are poorly understood. The objective of this study was evaluation of neuropathological, microbiological, and magnetic resonance imaging (MRI) findings in three patients with the Borrelia burgdorferi infection and neurological disease from whom brain tissue specimens were available. Perivascular or vasculitic lymphocytic inflammation was detected in all specimens. Large areas of demyelination in periventricular white matter were detected histologically and by MRI in one patient. The disease had a fatal outcome in this patient. Brain MRI suggested malignancies in two patients before histopathological studies were carried out. One of these two patients was a child with sudden hemiparesis. Another was a 40-year-old man presenting with epileptic seizures and MRI-detected multifocal lesions, which disappeared after repeated courses of antibiotics. We conclude that cerebral lymphocytic vasculitis and multifocal encephalitis may be associated with B. burgdorferi infection. The presence of B. burgdorferi DNA in tissue samples from areas with inflammatory changes indicates that direct invasion of B. burgdorferi may be the pathogenetic mechanism for focal encephalitis in LNB.

Cerebral Vasculitis and Stroke in Lyme Neuroborreliosis

“…This assumption is supported by occasional findings of Bb spirochetes or Bb DNA in brain tissue samples of affected patients [10], and the fact that excellent responses to a single course of antibiotic treatment have been repeatedly reported [7, 11, 15, 17]. As opposed to direct spirochetal invasion, neurological damage may also result from a response to molecular mimicry by sharing of antigenic determinants between Bb and human tissue [21].…”

“…A substantial number of reports on stroke due to LNB described patients younger than 30 years [6, 7, 10, 11, 14, 15, 17, 18, 20]. However, the observation that LNB might be more common in young stroke patients is probably biased, as workup of stroke etiology tends to be more extensive in young stroke victims.…”

“…Apart from that case, we are not aware of other publications on involvement of large extracranial brain-supplying arteries in LNB patients. Cerebral vasculitis in LNB can affect small [10,11,12] as well as medium-sized and large intracranial arteries [6, 12, 13,17,18,19,20]. Early publications on stroke due to LNB suggested a predilection of the vertebrobasilar territory [6, 7], but there have been more recent reports on predominant anterior circulation vasculitis [17,18,19,20].…”

“…Stroke due to LNB may manifest as subarachnoid hemorrhage [3, 4], intracerebral hemorrhage [5] and, most frequently reported, ischemic infarction [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]. We report on 2 patients with cerebral vasculitis and stroke due to LNB, and provide a review of current knowledge.…”

Transient Ischaemic Attack in a 5-Year-Old Girl due to Focal Vasculitis in Neuroborreliosis

“…Infection with B. burgdorferi spp. is a known cause of CNS vasculitis [4,5,6]. Based on our microbiological findings, we initiated an intravenous treatment with ceftriaxone.…”