Ischemic Strokes and other brain problems due to LD
Dement Geriatr Cogn Disord. 1997 Nov-Dec;8(6):384-90.
Borrelia burgdorferi-seropositive chronic encephalomyelopathy: Lyme
neuroborreliosis? An autopsied report.
Kobayashi K, Mizukoshi C, Aoki T, Muramori F, Hayashi M, Miyazu K, Koshino
Y, Ohta M, Nakanishi I, Yamaguchi N.
Department of Neuropsychiatry, Kanazawa University School of Medicine,
Japan.
Abstract
A 36-year-old Japanese woman presented with progressive cerebellar signs
and mental deterioration of subacute course after her return from the USA.
Her serum antibody to spirochete Borrelia burgdorferi was significantly
elevated. A necropsy 4 years after her initial neurological signs revealed
multifocal inflammatory change in the cerebral cortex, thalamus, superior
colliculus, dentate nucleus, inferior olivary nucleus and spinal cord. The
lesions showed spongiform change, neuronal cell loss, astrocytosis and
proliferation of activated microglial cells. The internal capsule was partially
vacuolated and the spinal cord, notably at the thoracic level, was demyelinated
and cavitated in the lateral funiculus. Microglial cells aggregated within
and around the spongiform lesions and microglial nodules were present in
the medulla oblongata. Use of Warthin-Starry stain demonstrated
silver-impregnated organisms strongly suggesting B. burgdorferi in the central nervous
tissues. The dentate nucleus and inferior olivary nucleus showed the most
advanced lesions with profound fibrillary gliosis. Occlusive vascular change
was relatively mild, and fibrous thickening of the leptomeninges with
lymphocyte infiltrates was localized in the basal midbrain. The ataxic symptoms
were due to the dentate and olivary nucleus lesions and mental
deterioration was attributable to the cortical and thalamic lesions. Spongiform
change, neuronal cell loss, and microglial activation are characteristic
pathological features in the present case. The cerebellar ataxia and subsequent
mental deterioration are unusual clinical features of Lyme neuroborreliosis.
Spirochete B. burgdorferi can cause focal inflammatory parenchymal change in
the central nervous tissues and the present case may be an encephalitic
form of Lyme neuroborreliosis.
PMID: 9370092
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