Ischemic strokes and other brain problems due to LD

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
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Yvonne
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Ischemic strokes and other brain problems due to LD

Post by Yvonne » Thu 4 Sep 2008 9:30

Rev Neurol (Paris). 2008 Aug 27. [Epub ahead of print]

[Recurrent ischemic strokes revealing Lyme meningovascularitis.]

[Article in French]


Sparsa L, Blanc F, Lauer V, Cretin B, Marescaux C, Wolff V.
Département de neurologie, hôpital Civil, hôpitaux universitaires, 1, place de l'Hôpital, 6700 Strasbourg, France.

INTRODUCTION: Infectious vascularitis is an unusual cause of ischemic stroke (IS). We report a case of Lyme meningovascularitis complicated with multiple IS. CASE REPORT: A 64-year-old man, without any cardiovascular risk factor, was admitted for a right hemiparesia with a left thalamic hypodensity on the initial cerebral CT scan. No cause for this presumed IS could be identified. Later, the patient developed cognitive impairment and a bilateral cerebellar syndrome. Multiple infarcts and multiple intracranial stenosis were seen on cerebral MRI with magnetic resonance angiography (MRA). Cerebrospinal fluid tests showed meningitis and positive Lyme serology with an intrathecal specific anti-Borrelia antibody index. Antibiotic treatment was followed by good biological and partial clinicoradiological outcome. CONCLUSION: The diagnosis of Lyme neuroborreliosis should be entertained as a possible cause of IS in highly endemic zones.

PMID: 18760428
Edit: Changed title of this topic.
Last edited by Yvonne on Tue 27 Jan 2009 9:48, edited 1 time in total.
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Joe Ham
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Re: Recurrent ischemic strokes revealing Lymemeningovascularitis

Post by Joe Ham » Fri 5 Sep 2008 2:57

Yvonne, you really started something with this thread!
Rev Neurol (Paris). 1988;144(12):765-75.
[Multiple neurologic manifestations of Borrelia burgdorferi infection]
[Article in French] http://www.ncbi.nlm.nih.gov/pubmed/3070690

Dupuis MJ.
Clinique St-Pierre, Ottignies, Belgique.

The neurological spectrum of Borrelia burgdorferi infections is still enlarging. We review epidemiological, pathological and serological data of Lyme disease.

The course of the disease is divided in three stages: stage 1 during the first month is characterised by erythema chronicum migrans and associated manifestations; stage 2 includes not only the classical European meningoradiculitis but also less specific neurological symptoms: isolated lymphocytic meningitis with an acute or even relapsing course, apparently idiopathic facial palsy, neuritis of other cranial nerves, polyneuritis cranialis, Argyll-Robertson sign, peripheral nerve involvement, acute transverse myelitis, severe encephalitis, myositis. During stage 3, three to five months or longer after the onset of the disease, chronic arthritis, acrodermatitis chronica atrophicans and various neurological symptoms can be observed: chronic neuropathy with mainly sensory or motor signs, recurrent strokes due to cerebral angiopathy and progressive encephalomyelitis; this third stage the central nervous system involvement is characterised by slowly progressive or fluctuating course during months or years, ataxic or spastic gait disorder, bladder disturbances, cranial nerve dysfunction including optic atrophy and hypoacusia, dysarthria, focal and diffuse encephalopathy.

This chronic central nervous system disease can mimic multiple sclerosis, anorexia nervosa, psychic disorders or subacute presenile dementia. It is often associated with pleiocytosis, abnormal EEG and evoked potentials, sometimes multifocal and mainly periventricular white matter lesions visualised by CT or MRI, and as a rule high antibody titers against Borrelia burgdorferi.

High doses of penicillin can halt the disease, sometimes induce spectacular regression of symptoms or sometimes be inefficient; ceftriaxone could be a more powerful therapy.

Similarities between syphilis and Borreliosis are multiple: both of these spirochetes contain plasmids, can be transmitted through the placenta and progress for many years through successive stages, with multiorgan symptoms, including parenchymatous and vascular lesions of the central nervous system. Borrelia burgdorferi is the new great imitator.

PMID: 3070690 [PubMed - indexed for MEDLINE]

Joe Ham
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Re: Recurrent ischemic strokes revealing Lymemeningovascularitis

Post by Joe Ham » Fri 5 Sep 2008 3:06

This abstract was posted to .sci.med, Oct 2006, by Sarah (CaliforniaLyme), one of her valiant attempts to post something
of value to that board as it was degenerating.
Arch Neurol. 1991 Aug;48(8):832-6.
Borrelia rhombencephalomyelopathy.
http://www.ncbi.nlm.nih.gov/pubmed/1898257

Kuntzer T, Bogousslavsky J, Miklossy J, Steck AJ, Janzer R, Regli F.
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Three patients, in whom the diagnosis of Borrelia burgdorferi infection was unknown for several years, developed a biphasic involvement of the central nervous system: an acute brain-stem dysfunction was followed up, in two patients, by a progressive, disabling myelitis and, in one patient, by further relapsing-remitting episodes of severe multifocal rhombencephalitis.
The most consistent cerebrospinal fluid abnormalities in the analysis of sequential specimens were elevated total IgM levels that normalized after penicillin therapy.

The neuropathologic findings in one patient showed microgliosis and meningovascular involvement of the central nervous system, resulting in two ischemic infarcts in the myelencephalon.
Few spirochetes were localized in the leptomeninges and around subependymal vessels of the fourth ventricle. The vascular element consisted of an obliterative inflammatory vasculopathy in the medullary parenchyma.

This study (1) provides pathologic evidence that a vascular disease induced by B burgdorferi is a pathogenetic mechanism for cerebrovascular diseases, and (2) emphasizes the similarities between neuroborreliosis and neurosyphilis.
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Last edited by Joe Ham on Tue 27 Jan 2009 17:25, edited 1 time in total.

Joe Ham
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Re: Recurrent ischemic strokes revealing Lymemeningovascularitis

Post by Joe Ham » Fri 5 Sep 2008 3:21

Stroke. 1993 Sep;24(9):1393-6.
Screening for neuroborreliosis in patients with stroke.
http://stroke.ahajournals.org/cgi/conte ... /24/9/1393

Hammers-Berggren S, Gröndahl A, Karlsson M, von Arbin M, Carlsson A, Stiernstedt G.
Department of Infectious Diseases, Danderyd Hospital, Sweden.

BACKGROUND AND PURPOSE: Borrelia burgdorferi, the etiologic agent of Lyme disease, can cause different neurological manifestations. We studied the prevalence of Lyme neuroborreliosis in patients with stroke.

METHODS: During a 1-year period, sera from patients with cerebral thrombosis or transient ischemic attack without cardioembolism were investigated for antibodies against B burgdorferi.

RESULTS: One of 281 patients had a positive serum immunoglobulin M titer and 23 of 281 (8%) had positive serum immunoglobulin G titers against B burgdorferi. One of the 24 seropositive patients, with a diagnosis of transient ischemic attack due to dysphasia, had a lymphocytic pleocytosis and intrathecal antibody production against B burgdorferi. The medical history revealed a 9-month period of general and neurological symptoms compatible with Lyme neuroborreliosis before the stroke like incidents.

CONCLUSIONS: We conclude that Lyme neuroborreliosis may imitate stroke, but screening for antibodies against B burgdorferi seems to be of little value and may be replaced by a careful medical history.

PMID: 8362437 [PubMed - indexed for MEDLINE]

Joe Ham
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Re: Recurrent ischemic strokes revealing Lymemeningovascularitis

Post by Joe Ham » Fri 5 Sep 2008 3:25

Arch Pediatr. 1999 Dec;6(12):1302-5.
[Ischemic stroke caused by neuroborreliosis]
[Article in French] http://www.ncbi.nlm.nih.gov/pubmed/10627902

Laroche C, Lienhardt A, Boulesteix J.
Service de pédiatrie II, CHU Dupuytren, Limoges, France.

Ischemic stroke in children is rare and its etiology is frequently unknown.
CASE REPORT: We report the case of a nine-year-old boy who presented a right ischemic lenticular stroke due to neuroborreliosis, with a good outcome after antibiotic treatment.
CONCLUSION: We suggest that it is important to search for neuroborreliosis in case of an ischemic stroke in children; the study of cerebral spinal fluid is a good diagnostic marker.

PMID: 10627902 [PubMed - indexed for MEDLINE]

Joe Ham
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Re: Recurrent ischemic strokes revealing Lymemeningovascularitis

Post by Joe Ham » Fri 5 Sep 2008 4:00

Arch Phys Med Rehabil. 2000 Apr;81(4):519-21.
Lyme neuroborreliosis mimics stroke: a case report.
http://www.ncbi.nlm.nih.gov/pubmed/10768546

Zhang Y, Lafontant G, Bonner FJ Jr.
Department of Physical Medicine and Rehabilitation, Graduate Hospital, Philadelphia, PA, USA.

Lyme neuroborreliosis is diagnostically challenging because of its diverse manifestations. The well-documented neurologic spectrum includes lymphocytic meningitis, cranial neuropathy, and radiculoneuritis in the early disseminated stage; and peripheral neuropathy, chronic encephalomyelitis, and mild encephalopathy in the late persistent stage.

This case report describes a 74-year-old man who developed progressive left hemiparesis and facial palsy. The patient was hospitalized to rule out a cerebral vascular accident. The diagnosis of Lyme borreliosis was established with serologic studies. The patient was treated with intravenous ceftriaxone and responded with rapid clinical and functional recovery. Lyme neuroborreliosis presenting as hemiparesis has rarely been reported. Prompt diagnosis and treatment appear to facilitate symptomatic relief and prevent persistent neurologic deficits.

PMID: 10768546 [PubMed - indexed for MEDLINE]

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Yvonne
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Re: Recurrent ischemic strokes revealing Lymemeningovascularitis

Post by Yvonne » Fri 5 Sep 2008 14:43

Neuroradiology. 1993;35(7):529-31.Links

Lyme disease presenting as a stroke in the vertebrobasilar territory: MRI.

Defer G, Levy R, Brugiéres P, Postic D, Degos JD.
Département de Neurosciences, CHU Henri Mondor, Créteil, France.

A 28-year-old female farmer, without vascular risk factors, developed a limited infarct of the pons, associated with a lymphocytic cerebrospinal fluid (CSF) pleocytosis. Titres of specific antibodies against Borrelia burgdorferi were high in serum and CSF. MRI confirmed an infarct in the territory of the medial pontine arteries, but angiography showed no evidence of cerebral angiopathy. Antibiotic therapy rapidly led to a return to normal of CSF cytology and serology. We suggest that Lyme disease is a possible cause of cerebral ischaemia.

PMID: 8232882
Listen to all,
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Joe Ham
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Re: Recurrent ischemic strokes revealing Lymemeningovascularitis

Post by Joe Ham » Sat 6 Sep 2008 5:12

Rev Neurol (Paris). 2000 Dec;156(12):1154-6.
[Left sided sudden hemiparesis linked to a central form of Lyme disease]
[Article in French] http://www.ncbi.nlm.nih.gov/pubmed/11139733

Deloizy M, Devos P, Stekelorom T, Testard D, Belhadia A.
Service de Neurologie, Centre Hospitalier de Boulogne S/Mer.

Lyme disease is known for its numerous neurological manifestations. Cerebral ischemic lesions are more rarely reported. We describe the case of a 27 - year old man - presenting with a left-sided hemiparesis when waking up.

We first thought of a stroke, due to the presence of a light right capsulo-thalamic hypodensity on C.T. scan and the spontaneous regression of the hemiparesis within a few days.
However, the lumbar puncture performed on the patient due to a fever running 38 degrees C and some drowziness showed a lymphocytic pleocytosis with a very inflammatory face of the spinal fluid. The M.R.I. revealed a right capsular and thalamic image with edema of the front part of the thalamus showing either a vascular or an inflammatory origin. The Lyme serodiagnosis in the blood and in the spinal fluid was positive, and we demonstrated an intrathecal Borrelia burgdorferi specific antibody synthesis.
This case is interesting because it shows a central form of neuroborreliosis through cerebral infarct and its regressive evolution under treatment. The possible pathophysiology mechanisms have been discussed.

PMID: 11139733 [PubMed - indexed for MEDLINE]

Joe Ham
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Re: Recurrent ischemic strokes revealing Lymemeningovascularitis

Post by Joe Ham » Sat 6 Sep 2008 5:17

Neurologia. 2001 Jan;16(1):43-5.
Spontaneous brain hemorrhage associated with Lyme neuroborreliosis.

http://www.ncbi.nlm.nih.gov/pubmed/11234662

Seijo Martínez M, Grandes Ibáñez J, Sánchez Herrero J, García-Moncó JC.
Servicio de Neurología, Complexo Hospitalario de Pontevedra, Lóureiro Crespo, s/n 36001 Pontevedra. mseijom@meditex.es

We present the case of a patient with late neuroborreliosis and a spontaneous temporal lobe hemorrhage.
Although ischemic stroke and subarachnoid hemorrhage have been reported in association with Lyme disease, intraparenchymal brain hemorrhage has not been previously described in the course of this disease.
The patient is a 48-year old male with a progressive spastic paraparesis of months' duration who presented acute headache, confusion, severe left hemiparesis with sensory deficit and homonymous hemianopsia. A cranial computed tomography scan showed an extensive right temporal lobe hemorrhage with subarachnoid invasion. Brain angiographic and angio-magnetic resonance imaging studies excluded hemorrhage-predisposing vascular abnormalities. Cerebrospinal fluid (CSF) studies disclosed mononuclear pleocytosis with elevated protein levels. Both serum and CSF anti-Borrelia titers were significantly increased, and serum Western Blot showed bands to protein 34 (ops B), 57, 59 and 62. The patient was treated with ceftriaxone for 4 weeks, with a favorable outcome.
It is suspected that cause of the hemorrhage was parenchymatous Lyme-associated vascular damage and/or microaneurysmatic rupture.

PMID: 11234662 [PubMed - indexed for MEDLINE]

Joe Ham
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Re: Recurrent ischemic strokes revealing Lymemeningovascularitis

Post by Joe Ham » Sat 6 Sep 2008 5:34

Ned Tijdschr Geneeskd. 2005 Aug 6;149(32):1785-90.

Erratum in:
Ned Tijdschr Geneeskd. 2005 Sep 24;149(39):2200.

[Clinical reasoning and decision-making in practice. An older man with prostate carcinoma and a painless paraparesis of the legs]
[Article in Dutch] http://www.ncbi.nlm.nih.gov/pubmed/16121663

Ruitenberg A, Vecht ChJ, van den Bent MJ, Taal W.
Erasmus MC, afd. Neurologie, Rotterdam.

A 78-year-old man with metastasised prostate carcinoma presented with a painless paraparesis. His cerebrospinal fluid showed elevated protein and a mononuclear pleiocytosis, but cytology investigations of 5 separate samples revealed no malignant cells in the cerebrospinal fluid.
Extensive viral and bacterial tests (including ELISA for Borrelia burgdorferi) of serum and cerebrospinal fluid were negative.
On the day radiation therapy for presumed leptomeningeal metastases was due to start the IgG and IgM Western blot for Borrelia were found to be positive, indicating neuroborreliosis.

Soon after the start of antibiotic therapy the paraparesis began to improve and after four weeks the patient had made a complete recovery. In patients with a progressive paraparesis, neuroborreliosis should be considered even in the absence of pain.

PMID: 16121663 [PubMed - indexed for MEDLINE]

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