Aphasia in Lyme Neuroborreliosis Not Associated with Dementia

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Aphasia in Lyme Neuroborreliosis Not Associated with Dementia

Post by inmacdonald » Tue 7 Mar 2017 17:32

Acute Lyme Neuroborreliosis With Transient Hemiparesis and Aphasia

DOI: http://dx.doi.org/10.1016/j.annemergmed.2015.01.011
Lyme disease often mimics other conditions and thus represents a diagnostic challenge, especially in an emergency department setting. We report a case of a female teenager presenting with sudden-onset aphasia and transient right-sided faciobrachial hemiplegia, along with headache and agitation. Ischemia, vasculitis, or another structural lesion was excluded by brain imaging. Toxicologic evaluation results were negative. Cerebral perfusion computed tomography and electroencephalography showed left parietotemporal brain dysfunction. Lumbar puncture result, although atypical, suggested bacterial infection and intravenous ceftriaxone was initiated. Finally, microbiological cerebrospinal fluid analysis revealed Lyme neuroborreliosis, showing specific intrathecal antibody production and high level of C-X-C motif chemokine 13. The patient rapidly recovered. To our knowledge, this report for the first time illustrates that acute-onset language and motor symptoms may be directly related to Lyme neuroborreliosis. Neuroborreliosis may mimic other acute neurologic events such as stroke and should be taken into diagnostic consideration even in the absence of classic symptoms and evolution.

Commentary by Lead author post publication:

--March 3, 2015 at 4:42AM
Swiss teenager with classic sudden symptoms of stroke diagnosed with Lyme disease

Saved from URL: http://www.news-medical.net/news/201503 ... sease.aspx

"Swiss teenager with classic sudden symptoms
of stroke diagnosed with Lyme disease
A Swiss teenager,recently returned home from a discotheque,came to the
emergency department with classic sudden symptoms of stroke, only to be
diagnosed withLymedisease.The highly unusual case presentation was
published online last Thursday in Annals of Emergency Medicine ("Acute Lyme
Neuroborreliosis with Transient Hemiparesis and Aphasia").
"Everything about her symptoms indicated stroke:speech deficits, poor
comprehension and rightsided face and arm weakness, so we considered
treating her with clot busting drugs"said lead study author Arseny Sokolov,
MD,of the Department of Clinical Neuroscience, Centre Hospitalier
Universitaire Vaudois in Lausanne,Switzerland."But a 16 year old having a
stroke,while not unheard of,would be quite rare so we looked at other
possibilities and found Lyme."
Brain imaging was not suggestive of stroke either, but revealed circumscribed
brain dysfunction.The treatment team performed a spinal tap.The patient's
spinal fluid showed elevated white blood cell counts and Lyme neuroborreliosis
was diagnosed,so the treatment team began a course of antibacterial and
antiviral agents.Thepatient improved immediately after treatment began.
"The imaging findings for the first time demonstrate acute brain dysfunction that
appears to be directly related to neuroborreliosis" said senior co-author
Renaud Du Pasquier,MD, neurology chairman at the Centre Hospitalier Universitaire
Vaudois in Lausanne."It may point out future perspectives for research
on the underlying mechanisms."
Lyme disease is caused by Borrelia burgdorferi bacteria, and is known as "the
great imitator,"as its symptoms can mimic so many other diseases. Many
patients have Lyme for a long time before a proper diagnosis is rendered.
When that happens, serious long term complications are the result.
"The uncommon set of symptoms our patient had show why Lyme is a
'chameleon disease' of the emergency department," said Dr. Sokolov.
"Furthermore,the patient had no history of tick bite.This curious case just
shows the careful detective work
that is involved in such a large portion of emergency medicine."
American College of Emergency Physicians

Test Results: Body Fluids Testing:
Labs Lyme Aphasia Part 1 0f 2.tif
Labs Lyme Aphasia Part 1 0f 2.tif (230.16 KiB) Viewed 3560 times
Labs Lyme Aphasia Part 2 of 2.tif
Labs Lyme Aphasia Part 2 of 2.tif (309.36 KiB) Viewed 3560 times


MacDonald's Comment:

NeuroLyme disease produced Aphasia in this teenager. There was no associated Dementia but there
was evidence of Brain Vasculitis which mimicked a Stroke. Actual Stroke was disproven by brain
imaging studies.

Primary Progressive Aphasia ( with Dementia) following Lyme Disease
has been presented in the New England Journal of Medicine
in a Clinicopathological Conference in year 2017.

Injury to the Speech Centers of the brain ( Wernicke and Broca areas)
was demonstrated in Brain Imaging studies in each of these cases.

Intervention with prompt Antibiotic therapy reversed many of the
Stroke like symptoms in the patient with Acute onset of Lyme Aphasia.

It is conceivable that Antibiotic Therapy
in Primary Progressive Aphasia early in the course of this chronic disease
might reverse the neurological and cognitive deficits of
Primary Progressive Aphasia.( PPA)
Body Fluid Testing of PPA patients should be mandatory
and CXCL13 testing of the spinal fluid along with Borrelia
(burgdorferi and miyamotoi) focused Protein detection in The
spinal fluid is in the best interest of PPA patients..


Alan B. MacDonald, M.D. FCAP
March 7 2017

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