Myelitis and Borreliosis/Lyme disease

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
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RitaA
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Myelitis and Borreliosis/Lyme disease

Post by RitaA » Mon 3 Sep 2012 8:19

http://www.ncbi.nlm.nih.gov/pubmed/7565839
Mov Disord. 1995 Jul;10(4):521-2.

Restless legs syndrome after a borrelia-induced myelitis.

Hemmer B, Riemann D, Glocker FX, Lücking CH, Deuschl G.

Source
Department of Neurology, University of Freiburg, Germany.

PMID:
7565839
[PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/8774608
Lancet. 1996 Aug 31;348(9027):624.

Lyme myelitis mimicking neurological malignancy.

Dryden MS, O'Connell S, Samuel W, Iannotti F.

PMID:
8774608
[PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/12532941
J Neurol. 2002 Oct;249(10):1472-4.

Acute myelitis in early Borrelia burgdorferi infection.

Lesca G, Deschamps R, Lubetzki C, Levy R, Assous M.

PMID: 12532941 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/12828297
J Spinal Cord Med. 2003 Summer;26(2):168-71.

Transverse myelitis secondary to coexistent Lyme disease and babesiosis.

Oleson CV, Sivalingam JJ, O'Neill BJ, Staas WE Jr.

Source

Department of Rehabilitation Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

Abstract

OBJECTIVE:

To describe transverse myelitis secondary to coexistent Lyme disease and babesiosis.

METHOD:

Case report.

BACKGROUND:

A 74-year-old man presented with rapid onset of weakness, numbness, and tingling in his legs, with symptoms ascending to his hands and forearms within days. He recalled an insect bite to his scapular area 2 weeks earlier.

FINDINGS:

T2-weighted magnetic resonance imaging demonstrated diffuse hyperintensity from T1 through T12. Western blot and enzyme-linked immunosorbent assay identified infection with Borrelia burgdorferi, the spirochete responsible for Lyme disease. Giemsa-stained blood smears identified ring forms later recognized by polymerase chain reaction as Babesia microti, the piroplasm responsible for babesiosis. Initial examination revealed C7 motor and T3 sensory complete tetraplegia, with recovery to T4 paraplegia by 2 months.

CONCLUSION:

The history, physical examination, imaging, and serologic studies were consistent with transverse myelitis related to Lyme disease and babesiosis. The severity and permanence of this patient's deficits were greater than those reported in the majority of previous cases of transverse myelitis due to Lyme disease alone, suggesting a possible role for coinfection with babesiosis.

PMID: 12828297 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/15528925
Eur Neurol. 2004;52(3):186-8. Epub 2004 Nov 2.

Acute transverse myelitis as a main manifestation of early stage II neuroborreliosis in two patients.

Meurs L, Labeye D, Declercq I, Piéret F, Gille M.

Source

Department of Neurology, Clinique Sainte-Elisabeth, Brussels, Belgium.

PMID: 15528925 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/18033042
Rev Neurol (Paris). 2007 Nov;163(11):1039-47.

[Acute myelitis and Lyme disease].

[Article in French]

Blanc F, Froelich S, Vuillemet F, Carré S, Baldauf E, de Martino S, Jaulhac B, Maitrot D, Tranchant C, de Seze J.

Source

Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg [France]

Abstract

INTRODUCTION:

Acute myelitis accounts for 4 to 5 percent of all cases of neuroborreliosis. In the literature, simultaneous spinal MRI and cerebrospinal fluid (CSF) investigations are presented for only 8 cases. We describe here 3 cases of acute Lyme myelitis.

METHOD:

In a cohort of 45 patients with neuroborreliosis, diagnosed between January 1998 and January 2005, 3 had acute myelitis. Clinical, biological and radiological data were studied.

CASE REPORTS:

The three patients had motor, sensorial and sphincter involvement. Extra-spinal involvement, such as fever and headache for one, facial nerve palsy for the second and subarachnoid hemorrhage for the third, was also noted. Pleocytosis varied from 10 to 520 white cells per mm3. Lyme serology was positive in CSF for all. Intrathecal anti-Borrelia antibody index was positive or intermediate for all three patients. Spinal cord MRI revealed a large hyperintense zone involving more than 3 vertebral segments. Myelitis was central, posterior or transverse in the axial plane. The clinical course was favorable after a three-week course of appropriate antibiotics.

CONCLUSION:

These 3 cases and the others from the literature show the diversity of the clinical and radiological features of acute myelitis: transverse, central or posterior myelitis. Thus, Lyme serology in CSF in indicated for patients presenting acute myelitis, particularly in endemic areas.

PMID:
18033042
[PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/19675732
Ger Med Sci. 2008 Jun 10;6:Doc04.

Subacute transverse myelitis with Lyme profile dissociation.

Walid MS, Ajjan M, Ulm AJ.

Source
Medical Center of Central Georgia, Macon, GA, USA.

Abstract

INTRODUCTION:

Transverse myelitis is a very rare neurologic syndrome with an incidence per year of 1-5 per million population. We are presenting an interesting case of subacute transverse myelitis with its MRI (magnetic resonance imaging) and CSF (cerebrospinal fluid) findings.

CASE:

A 46-year-old African-American woman presented with decreased sensation in the lower extremities which started three weeks ago when she had a 36-hour episode of sore throat. She reported numbness up to the level just below the breasts. Lyme disease antibodies total IgG (immunoglobulin G) and IgM (immunoglobulin M) in the blood was positive. Antinuclear antibody profile was within normal limits. MRI of the cervical spine showed swelling in the lower cervical cord with contrast enhancement. Cerebrospinal fluid was clear with negative Borrelia Burgdorferi IgG and IgM. Herpes simplex, mycoplasma, coxiella, anaplasma, cryptococcus and hepatitis B were all negative. No oligoclonal bands were detected. Quick improvement ensued after she was given IV Ceftriaxone for 7 days. The patient was discharged on the 8(th) day in stable condition. She continued on doxycycline for 21 days.

CONCLUSIONS:

Transverse myelitis should be included in the differential diagnosis of any patient presenting with acute or subacute myelopathy in association with localized contrast enhancement in the spinal cord especially if flu-like prodromal symptoms were reported. Lyme disease serology is indicated in patients with neurological symptoms keeping in mind that dissociation in Lyme antibody titers between the blood and the CSF is possible.

PMID:
19675732
[PubMed]
PMCID:
PMC2703261
Free PMC Article
The full article is available here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2703261/


http://www.ncbi.nlm.nih.gov/pubmed/21686762
BMJ Case Rep. 2009;2009. pii: bcr07.2008.0527. Epub 2009 Jan 23.

Poliomyelitis-like syndrome with matching magnetic resonance features in a case of Lyme neuroborreliosis.

Charles V, Duprez TP, Kabamba B, Ivanoiu A, Sindic CJ.

Source

Service de Neurologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.

Abstract

Lyme disease is a multisystemic disorder caused by an epizootic organism of the spirochete group, called Borrelia burgdorferi (Bb), which is transmitted to humans by ticks of the genus Ixodes. Lyme neuroborreliosis may occur during the early dissemination phase, most often as a painful meningo-radiculitis and very rarely as a radiculo-myelitis, whereas encephalomyelitis is observed in the late phase. We report the case of a patient with an early subacute poliomyelitis-like syndrome closely matching the selective involvement of the anterior horns and roots of the cervical spinal cord seen on magnetic resonance (MR) imaging. This condition improved with appropriate antibiotics.

PMID:
21686762
[PubMed]
PMCID:
PMC3029854
Free PMC Article
The full article is available here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117552/
[snip]

Recently, eight documented cases of early subacute Bb myelitis have been reported.2 In six of these cases, painful radicular symptoms appeared before spinal cord signs. Most patients exhibited CSF mononuclear pleocytosis and cervical spinal cord lesions on MRI. All but one patient had a favourable outcome with appropriate intravenous antibiotherapy. Absence of encephalitic involvement and cranial nerve palsy, frequent combination with meningoradiculitis and good response to antibiotherapy are key features allowing discrimination between early and late variants of Bb myelitis.

Leptomeningeal enhancement and nerve root enhancement of the cauda equina on post‐contrast T1 weighted MR images have been reported in spinal Lyme neuroborreliosis.4 Enhancement of the cervical nerve roots has also been reported in this condition.5 Concomitant enhancement of the leptomeninges, anterior horns and anterior radicelles of the cervical spine has never been described to date. The close correlation between clinical and MR features was a prominent feature of this clinically and radiologically atypical case of Lyme neuroborreliosis.
http://www.ncbi.nlm.nih.gov/pubmed/20120216
Acta Neurol Belg. 2009 Dec;109(4):326-9.

Lyme disease presenting as subacute transverse myelitis.

Koc F, Bozdemir H, Pekoz T, Aksu HS, Ozcan S, Kurdak H.

Source

Department of Neurology, Cukurova University School of Medicine, Adana, Turkey.

Abstract

Lyme disease (borreliosis) is a systemic illness resulting from infection with the spirochete Borrelia burgdorferi. It is transmitted to humans by the bites of infected ticks belonging to several species of the genus Ixodes. After the bacteria enter the body via the dermis, most patients develop the early, localised form of Lyme disease, which is characterised by erythema migrans and influenza-like symptoms. This disease may also affect the heart, nervous system and joints. The neurological findings of this disease may include peripheral and central nervous system signs. A 21-year-old woman attended a family medicine outpatient clinic complaining of unexplained pain and muscle power loss in her lower extremities. The problem had started in her right leg 3 months earlier and worsened in the last week. She had a neurology consultation and was hospitalised. Her neurological examination revealed bilateral facial paralysis and sensory impairment. Immunoglobulin M antibody to B. burgdorferi was positive on Western blotting in both serum and cerebrospinal fluid. The patient was diagnosed with subacute neuroborreliosis and treated.

PMID: 20120216 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/20505978
Infection. 2010 Oct;38(5):413-6. Epub 2010 May 27.

Acute transverse myelitis in Lyme neuroborreliosis.

Bigi S, Aebi C, Nauer C, Bigler S, Steinlin M.

Source

Neuropaediatrics, Department of Paediatrics, University Children's Hospital, Inselspital, Bern, Switzerland.

Abstract

INTRODUCTION:

Acute transverse myelitis (ATM) is a rare disorder (1-8 new cases per million of population per year), with 20% of all cases occurring in patients younger than 18 years of age. Diagnosis requires clinical symptoms and evidence of inflammation within the spinal cord (cerebrospinal fluid and/or magnetic resonance imaging). ATM due to neuroborreliosis typically presents with impressive clinical manifestations.

CASE PRESENTATION:

Here we present a case of Lyme neuroborreliosis-associated ATM with severe MRI and CSF findings, but surprisingly few clinical manifestations and late conversion of the immunoglobulin G CSF/blood index of Borrelia burgdorferi sensu lato.

CONCLUSION:

Clinical symptoms and signs of neuroborrelial ATM may be minimal, even in cases with severe involvement of the spine, as shown by imaging studies. The CSF/blood index can be negative in the early stages and does not exclude Lyme neuroborreliosis; if there is strong clinical suspicion of Lyme neuroborreliosis, appropriate treatment should be started and the CSF/blood index repeated to confirm the diagnosis.

PMID: 20505978 [PubMed - indexed for MEDLINE]
Here's a description of transverse myelitis:

http://www.hopkinsmedicine.org/healthli ... is_134,24/
Transverse Myelitis

Transverse myelitis is a neurological condition that happens when both sides of the same section of the spinal cord become inflamed. This inflammation can damage myelin, the fatty substance that covers your nerves. Loss of myelin often leads to spinal cord scarring that blocks nerve impulses and results in physical problems.

Transverse myelitis is a relatively rare disease. It occurs most often in children ages 10 to 19 and in adults ages 30 to 39, but it can happen at any age.

Causes

Experts don’t know the exact cause of transverse myelitis. The inflammation that leads to transverse myelitis can result as a side effect of a number of other conditions, including:

Lyme disease

• Syphilis

• Measles

• Viral infections

• Bacterial infections

Some people may also get transverse myelitis as a result of spinal injuries, spinal malformations, or vascular diseases like atherosclerosis, all of which can reduce the amount of oxygen in spinal cord tissue. If parts of the spinal cord don’t have enough oxygen, nerve cells often begin to die. The dying tissue can cause the inflammation that leads to transverse myelitis.

Transverse myelitis can also be a warning sign of multiple sclerosis, but this is a rare occurrence. Since some people with transverse myelitis have autoimmune diseases such as lupus, some doctors believe that transerve myelitis may also be an autoimmune disease. Finally, some cancers can trigger an immune response that leads to transverse myelitis.

Symptoms

The physical symptoms of transverse myelitis can develop over several hours or days, or over a longer period of one to two weeks. These are possible symptoms:

• Back or neck pain

• Weakness in arms or legs

• Abnormal feelings in the legs, such as burning, tingling, or pricking

• Loss of bladder or bowel control

• Heightened sensitivity to touch

The location on the body of these symptoms depends on what part of the spinal cord is inflamed. People with inflammation in the neck typically feel symptoms from the neck down, while inflammation in the middle of the spine can cause symptoms from the waist down.

[snip]

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