What Lyme Can Do to Your Brain in Just 4 Years

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Dement Geriatr Cogn Disord. 1997 Nov-Dec;8(6):384-90. Related

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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.

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.

Publication Types:

Case Reports

PMID: 9370092 [PubMed - indexed for MEDLINE]