Nervous system Lyme disease, chronic Lyme disease, and none of the above

Abstract

Lyme borreliosis, infection with the tick-borne spirochete Borrelia burgdorferi sensu lato, causes nervous system involvement in 10-15 % of identified infected individuals. Not unlike the other well-known spirochetosis, syphilis, infection can be protracted, but is microbiologically curable in virtually all patients, regardless of disease duration. Diagnosis relies on 2-tier serologic testing, which after the first 4-6 weeks of infection is both highly sensitive and specific. After this early, acute phase, serologic testing should rely only on IgG reactivity. Nervous system involvement most commonly presents with meningitis, cranial neuritis and radiculoneuritis, but can also present with a broader array of peripheral nervous system manifestations. Central nervous system infection typically elicits a cerebrospinal fluid pleocytosis and, often, intrathecal production of specific antibody, findings that should not be expected in disease not affecting the CNS. Treatment with recommended courses of oral or, when necessary, parenteral antibiotics is highly effective. The attribution of chronic, non-specific symptoms to "chronic Lyme disease", in the absence of specific evidence of ongoing B. burgdorferi infection, is inappropriate and unfortunate, leading not only to unneeded treatment and its associated complications, but also to missed opportunities for more appropriate management of patients' often disabling symptoms.

Pediatric stroke related to Lyme neuroborreliosis: Data from the Swiss NeuroPaediatric Stroke Registry and literature review

“…[29] Biological confirmation of LNB is mandatory and caution should be exercised before establishing the diagnosis, which has been blamed for a number of unexplained, badly systematized neurological symptoms. [30][31][32] As direct detection of the spirochete bv culture or by PCR has very low sensitivity, the diagnosis of LNB relies on a set of serological and biological arguments. Demonstration of B. burgdorferi specific antibodies in both the serum and in the CSF is essential and this was present in all reported cases.…”

Estimation of hearing impairment occurrence in patients with Lyme borreliosis – preliminary study

“…Some of the publications present such disorders as the only manifestation of the infection, while others consider them concomitant symptoms of diverse forms of neuroborreliosis [57,58,59,60]. The studies of LNB addressing the question of cranial nerve injury, point first of all to paresis or palsy of nerve VII, while only some of them refer to the possibility of affected nerve VIII, not related to changes on subsequent levels of the auditory pathway or mechanisms coordinating the process of balance [48,61,62,63,64]. Taking into consideration the structure of the organ of hearing and its pathways in the central nervous sys-tem, the pathomechanisms of the disorders presented above may have a role in B. burgdorferi sensu lato infections lasting for weeks or years.…”

Progression of tumefactive demyelinating lesion in a child demonstrated with MRI

“…Tumefactive demyelinating lesions (TDLs), also named “demyelinating pseudotumors,” are rare subsets of demyelinating manifestations. The exact pathogenesis of TDLs is not clearly understood [1] , [2] , [3] , [4] . They can occur in isolation, as part of multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), or neuromyelitis optica spectrum disorder (NMOSD) [5] .…”

“…They can occur in isolation, as part of multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), or neuromyelitis optica spectrum disorder (NMOSD) [5] . MS accounts for most cases of TDLs [3] , [6] . TDLs might be single or multiple and may appear simultaneously at onset or sequentially.…”

“…TDLs might be single or multiple and may appear simultaneously at onset or sequentially. When they appear as single mass lesion, they might be mistaken for brain tumors [1] , [2] , [3] . Clinical manifestations vary from asymptomatic lesions to headache, cognitive abnormalities, mental confusion, impaired consciousness, aphasia, apraxia, cerebellar symptoms, visual field defects, or seizures [1] , [2] , [4] .…”