Extracts from the full article:Neurol. Croat. Vol. 63, 1-2, 2014
Neuroborreliosis: diagnostic problem in distinguishing from multiple sclerosis
L. Radolović Prenc1, S. Telarović2,3, I. Vidović1, Ž. Jotanović4, L. Labinac-Peteh5, J. Sepčić6
ABSTRACT - Objectives: To present the importance of additional diagnostic procedures in differential diagnosis of multiple sclerosis and neuroborreliosis, exemplified by a case of our patient. Neurological manifestation of Lyme disease varies and sometimes can imitate multiple sclerosis, especially in the early disseminated or late phase when there are no data on clinical infection. Case report: We present a patient with neuroborreliosis, initially considered as multiple sclerosis. Positive serology for Borrelia burgdorferi is an indicator of a past infection. However, the presence of specific IgG and IgM antibodies in the CSF confirms the diagnosis. In our case, magnetic resonance imaging (MRI) of the brain showed normal findings, whereas during spinal cord MRI, edema and hyperintense lesions of the thoracic spinal cord were found. Visually evoked potentials revealed prolonged latencies of the P wave on the left side. CSF analysis showed proteinorrhachia and distinct pleocytosis, with positive serology for specific antibodies to Borrelia burgdorferi. Conclusion: The clinical symptoms, MRI and CSF findings in combination with good response to antibiotic therapy confirmed the diagnosis of neuroborreliosis.
Key words: neuroborreliosis, Lyme borreliosis, encephalomyelitis, multiple sclerosis
Neuroborreliosis can sometimes clinically mimic MS (11,12). There may be various neurologic deficits such as spastic paraparesis, hemiparesis, crossmyelitis, cerebellar ataxia, cranial or/and peripheral nerve damage, encephalitis, making it difficult to distinguish these two diseases (13). In the case of neuroborreliosis, MRI shows periventricular white matter damage, just like MS (1). As with other types of meningitis, MRI enhanced with contrast shows meningeal adhesions, which are not typical for MS (2,14,15). It is difficult to diagnose neuroborreliosis using laboratory analysis. Serologic tests for the detection of antibodies to Bb can be useful, but they could be positive in other CNS diseases like MS (16).
A large number of patients with neuroborreliosis are still found within the groups of patients erroneously diagnosed with MS. This is due to the similarity of clinical symptoms and MRI findings of CNS (19,20), as well as to the fact that the concentration of specific IgG oligoclonal bands depends on the duration of disease. In the case of intrathecal synthesis of specific IgG and IgM antibodies, especially for Borrelia burgdorferi, without the virus-specific immune response, we can with high certainty claim that it is a case of Lyme disease. Additional diagnostic indicators are significant damage to the bloodbrain barrier, as well as the presence of Borrelia burgdorferi in the CSF culture (21).