Inflammatory brain changes in Lyme borreliosis.

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Inflammatory brain changes in Lyme borreliosis. A report on three patients

and review of literature.

Oksi J, Kalimo H, Marttila RJ, Marjamäki M, Sonninen P, Nikoskelainen J,

Viljanen MK

Brain 1996 Dec 119 ( Pt 6) 2143-54

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Brain . Volume 119 ( Pt 6)

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Abstract

Despite a rapid increase in the number of patients with Lyme

neuroborreliosis (LNB), its neuropathological aspects are poorly understood.

The objective of this study was evaluation of neuropathological,

microbiological, and magnetic resonance imaging (MRI) findings in three

patients with the Borrelia burgdorferi infection and neurological disease

from whom brain tissue specimens were available. Perivascular or vasculitic

lymphocytic inflammation was detected in all specimens. Large areas of

demyelination in periventricular white matter were detected histologically

and by MRI in one patient. The disease had a fatal outcome in this patient.

Brain MRI suggested malignancies in two patients before histopathological

studies were carried out. One of these two patients was a child with sudden

hemiparesis. Another was a 40-year-old man presenting with epileptic

seizures and MRI-detected multifocal lesions, which disappeared after

repeated courses of antibiotics. We conclude that cerebral lymphocytic

vasculitis and multifocal encephalitis may be associated with B. burgdorferi

infection. The presence of B. burgdorferi DNA in tissue samples from areas

with inflammatory changes indicates that direct invasion of B. burgdorferi

may be the pathogenetic mechanism for focal encephalitis in LNB.

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