Chronic Central Nervous System Involvement

  • R. Martin
  • W. Kohlhepp
  • H. G. Mertens

Abstract

Although the meninges and nerve roots are more commonly involved during Lyme borreliosis, especially in Europe, numerous reports from Europe and the United States have documented the occurrence of acute and chronic manifestations in the brain or spinal cord (Ackermann et al. 1985; Klenk et al. 1985; Pfister et al. 1985; Reik et al. 1986; Kohlhepp et al. 1987; Behringer and Wirbatz 1987; Weder et al. 1987; Wokke et al. 1987a; Kohler et al. 1988; Halperin et al. 1989). The following chapter describes the clinical features and necessary investigations which help in the diagnosis of chronic central nervous system (CNS) involvement during Lyme borreliosis.

Keywords

Fatigue Dementia Tuberculosis Angiotensin Neurol 

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References

  1. Aberer E, Brunner C, Suchanek G, Klade H, Barbour A, Stanek G, Lassmann H (1989) Molecular mimicry and Lyme borreliosis: a shared antigenic determinant between Borrelia burgdorferi and human tissue. Ann Neurol 26:732–737PubMedCrossRefGoogle Scholar
  2. Ackermann R, Gollmer E, Rehse-Küpper B (1985) Progressive Borrelien-Enzephalomyelitis. Dtsch Med Wochenschr 110:1039–1042PubMedCrossRefGoogle Scholar
  3. Ackermann R, Rehse-Küpper B, Gollmer E, Schmidt R (1988) Chronic neurologic manifestations of erythema migrans borreliosis. Ann NY Acad Sci 539:16–23PubMedCrossRefGoogle Scholar
  4. Barbour AG (1988) Laboratory aspects of Lyme borreliosis. Clin Microbiol Rev 1:399–414PubMedGoogle Scholar
  5. Behringer A, Wirbatz A (1987) Chronische Borrelien-Erkrankung des zentralen Nervensystems. Nervenarzt 58:564–567PubMedGoogle Scholar
  6. Bensch J, Oleen P, Hagberg L (1987) Destructive chronic Borrelia meningoencephalitis in a child untreated for 15 years. Scand J Infect Dis 19:697–700PubMedCrossRefGoogle Scholar
  7. Burke JM, Schaberg DR (1985) Neurosyphilis in the antibiotic era. Neurology 35:1368–1371PubMedGoogle Scholar
  8. Delpech B, Lichtblau E (1972) Étude quantitative des immunoglobulines G et de l’albumine du liquide céphalorachidien. Clin Chim Acta 37:15–23PubMedCrossRefGoogle Scholar
  9. Hänny PE, Häuselmann HJ (1987) Die Lyme-Krankheit aus der Sicht des Neurologen. Schweiz Med Wochenschr 117:901–915PubMedGoogle Scholar
  10. Halperin JJ, Luft BJ, Anand AK et al. (1989) Lyme borreliosis: central nervous system manifestations. Neurology 39:753–759PubMedGoogle Scholar
  11. Hansen K, Rechnitzer C, Pedersen NS, Arpi M, Jessen O (1986) Borrelia meningitis in Denmark. Zentralbl Bakteriol Hyg (A) 263:348–350Google Scholar
  12. Henriksson A, Link H, Cruz M, Stiernstedt G (1986) Immunoglobulin abnormalities in cerebrospinal fluid and blood over the course of lymphocytic meningoradiculitis (Bannwarth’s syndrome). Ann Neurol 20:337–345PubMedCrossRefGoogle Scholar
  13. Klenk W, Heitmann R, Ackermann R (1985) Rezidivierende Erythema-Chronicum-Migrans- Krankheit des Nervensystems: Querschnittsmyelitis als Rückfall einer Meningopolyneuritis Garin-Bujadoux-Bannwarth. Akt Neurol 12:20–23CrossRefGoogle Scholar
  14. Kohler J, Kern U, Kasper J, Rhese-Küpper B, Thoden U (1988) Chronic central nervous system in Lyme borreliosis. Neurology 38:863–867PubMedGoogle Scholar
  15. Kohlhepp W, Mertens HG, Oschmann P, Rohrbach E (1987) Akute und chronische Erkrankungen bei zeckenvermittelter Borreliose. Nervenarzt 58:557–563PubMedGoogle Scholar
  16. Kohlhepp W, Kuhn W, Krüger H (1989) Extrapyramidal features in central Lyme borreliosis. Eur Neurol 29:150–155PubMedCrossRefGoogle Scholar
  17. Kollikowski HH, Schwendemann G, Schulz M, Wilhelm H, Lehmann HJ (1988) Chronic Borrelia encephalomyeloradiculitis with severe mental disturbance: immunosuppressive versus antibiotic therapy. J Neurol 235:140–142PubMedCrossRefGoogle Scholar
  18. Krüger H, Reuss K, Pulz M, Rohrbach E, Pflughaupt KW, Martin R, Mertens HG (1989) Meningoradiculitis and encephalomyelitis due to Borrelia burgdorferi: a follow-up study of 72 patients over 27 years. J Neurol 236:322–328PubMedCrossRefGoogle Scholar
  19. Macdonald AB, Miranda JM (1987) Concurrent neocortical borreliosis and Alzheimer’s disease. Hum Pathol 18:749–761CrossRefGoogle Scholar
  20. Martin R, Martens U, Sticht-Groh V, Dörries R, Krüger H (1988a) Persistent intrathecal secretion of oligoclonal, Borrelia burgdorferi-specific IgG in chronic meningoradiculitis. J Neurol 235:229–233PubMedCrossRefGoogle Scholar
  21. Martin R, Ortlauf J, Sticht-Groh V, Bogdahn U, Goldmann SF, Mertens HG (1988b) Borrelia burgdorferi-specific and autoreactive T cell lines from cerebrospinal fluid in Lyme radicu- lomyelitis. Ann Neurol 24:509–516PubMedCrossRefGoogle Scholar
  22. Martin R, Meinck HM, Schulte-Mattler W, Ricker K, Mertens HG (1990) Borrelia burgdorferi myelitis presenting as a partial stiff-man syndrome. J Neurol 237:51–54PubMedCrossRefGoogle Scholar
  23. May EF, Jabbari B (1990) Stroke in neuroborreliosis. Stroke 21:1232–1235PubMedCrossRefGoogle Scholar
  24. Mertens HG, Kohlhepp W, Martin R (1989) Die Borrelienenzephalitis und -myelitis. In Fischer PA, Baas H, Enzensberger W (eds) Gerontoneurologie, Enzephalitiden, Neurogenetik. Springer, Berlin Heidelberg New York, pp 396–407 (Verhandlungen der Deutschen Gesellschaft für Neurologie, vol. 5)Google Scholar
  25. Midgard R, Hofstad H (1987) Unusual manifestations of nervous system Borrelia burgdorferi infection. Arch Neurol 44:781–783PubMedGoogle Scholar
  26. Murray N, Kristoferitsch W, Stanek g, Steck AJ (1986) Specificity of CSF antibodies against components of Borrelia burgdorferi in patients with meningopolyneuritis Garin-Bujadoux-Bannwarth. J Neurol 233:224–227PubMedCrossRefGoogle Scholar
  27. Pachner AR (1989) Lyme disease. TINS 12:177–181PubMedGoogle Scholar
  28. Pachner AR, Steere AC, Sigal LH, Johnson CJ (1985) Antigen-specific proliferation of CSF lymphocytes in Lyme disease. Neurology 35:1642–1644PubMedGoogle Scholar
  29. Pachner AR, Duray P, Steere AC (1989) Central nervous system manifestations of Lyme disease. Arch Neurol 46:790–795PubMedGoogle Scholar
  30. Papolla MA, Omar R, Saran B, Andorn A, Suarez M, Pavia C, Weinstein A, Shank D, Davis K, Burgdorfer W (1989) Concurrent neuroborreliosis and Alzheimer’s disease: analysis of evidence. Hum Pathol 20:753–757CrossRefGoogle Scholar
  31. Pfister HW, Einhäupl K, Preac-Mursic V, Wilske B, Schierz G (1984) The spirochetal etiology of lymphocytic eningoradiculitis of Bannwarth (Bannwarth’s syndrome). J Neurol 231: 141–144PubMedCrossRefGoogle Scholar
  32. Pfister HW, Einhäupl K, Preac-Mursic V, Wilske B (1985) Lyme disease: commentary from Europe. Similarity of neurologic manifestations of Borrelia burgdorferi infections in America and Europe. Neurology 35:1393–1394Google Scholar
  33. Pfister HW, Preac-Mursic V, Wilske B, Einhäupl KM, Weinberger K (1989) Latent Lyme neuroborreliosis: presence of Borrelia burgdorferi in the cerebrospinal fluid without concurrent inflammatory signs. Neurology 39:1118–1120PubMedGoogle Scholar
  34. Pflüger KH, Reimers CD, Neubert U et al. (1988) Erythema migrans borreliosis: an HLA-associated disease? Ann NY Acad Sci 539:414–416CrossRefGoogle Scholar
  35. Reiber H (1980) The discrimination between different blood-CSF barrier dysfunctions and inflammatory reactions of the CNS by a recent evaluation graph for the protein profile of cerebrospinal fluid. J Neurol 224:89–99PubMedCrossRefGoogle Scholar
  36. Reik L, Smith L, Khan A, Nelson W (1985) Demyelinating encephalopathy in Lyme disease. Neurology 35:267–269PubMedGoogle Scholar
  37. Reik L, Burgdorfer W, Donaldson JO (1986) Neurologic abnormalities in Lyme disease without erythema chronicum migrans. Am J Med 81:73–78PubMedCrossRefGoogle Scholar
  38. Rosa PA, Schwan TG (1989) A specific and sensitive assay for the Lyme disease spirochete Borrelia burgdorferi using the polymerase chain reaction. J Infect Dis 160:1018–1029PubMedCrossRefGoogle Scholar
  39. Rowland LP (ed) (1989) Textbook of neurology, 8th edn. Lea and Febiger (Philadelphia), pp 152–161Google Scholar
  40. Rousseau JJ, Lust C, Zangerle PF, Bigaignon G (1986) Acute transverse myelitis as presenting neurological feature of Lyme disease. Lancet II: 1222–1223CrossRefGoogle Scholar
  41. Schaltenbrand G (1962) Radikulomyelomeningitis nach Zeckenbiss. Munch Med Wochenschr 18:829–834Google Scholar
  42. Schlüsener HJ, Martin R, Sticht-Groh V (1989) Autoimmunity in Lyme disease: molecular cloning of antigens recognized by antibodies in the cerebrospinal fluid. Autoimmunity 2:323–330CrossRefGoogle Scholar
  43. Steere AC (1989) Lyme disease. N Engl J Med 321:586–596PubMedCrossRefGoogle Scholar
  44. Steere AC, Hardin JA, Ruddy S, Mummaw JG, Malawista SE (1979) Lyme arthritis: correlation of serum and cryoglobulin I with activity, and serum I with remission. Arthritis Rheum 22:471–483PubMedCrossRefGoogle Scholar
  45. Sticht-Groh V, Martin R, Schmidt-Wolf I (1988) Antibody titer determinations against Borrelia burgdorferi in blood donors and in two different groups of patients. Ann NY Acad Sci 539:497–499CrossRefGoogle Scholar
  46. Stiernstedt G, Sköldenberg B, Vandvik B et al. (1984) Chronic meningitis and Lyme disease in Sweden. Yale J Biol Med 57:491–497PubMedGoogle Scholar
  47. Suchanek G, Kristoferitsch W, Stanek G, Bernheimer H (1986) Anti-myelin antibodies in cerebrospinal fluid and serum of patients with meningopolyneuritis Garin-Bujadoux-Bannwarth and other neurological diseases. Zentralbl Bakteriol Hyg (A) 263:160–168Google Scholar
  48. Uldry PA, Regli F, Bogousslavsky J (1987) Cerebral angiopathy and recurrent strokes following Borrelia burgdorferi infection. J Neurol Neurosurg Psychiatry 50:1703–1704PubMedCrossRefGoogle Scholar
  49. Vandvik B, Sköldenberg B, Stiernstedt G (1984) Tick-borne spirochetal meningitis, meningoradiculitis and meningoencephalitis. A report on 15 cases identified by demonstration of intrathecal spirochete-specific I antibody responses. Acta Neurol Scand 70:379–380Google Scholar
  50. Veenendaal-Hilbers JA, Perquin WVM, Hoogland PH, Doornbos L (1988) Basal meningovascu- litis and occlusion of the basilar artery in two cases of Borrelia burgdorferi infection. Neurology 38:1317–1319PubMedGoogle Scholar
  51. Weber K, Bratzke H-J, Neubert U, Wilske B, Duray PH (1988) Borrelia burgdorferi in a newborn despite oral penicillin for Lyme borreliosis during pregnancy. Pediatr Infect Dis J 7:286–289PubMedCrossRefGoogle Scholar
  52. Weder B, Wiedersheim P, Matter L, Steck A, Otto F (1987) Chronic progressive neurological involvement in Borrelia burgdorferi infection. J Neurol 234:40–43PubMedCrossRefGoogle Scholar
  53. Wilske B, Schierz G, Preac-Mursic V et al. (1986) Intrathecal production of specific antibodies against Borrelia burgdorferi in patients with lymphocytic meningoradiculitis (Bannwarth’s syndrome). J Infect Dis 153:304–313PubMedCrossRefGoogle Scholar
  54. Wokke JHJ, van Gijn J, Elderson A, Stanek G (1987a) Chronic forms of Borrelia burgdorferi infection of the nervous system. Neurology 37:1031–1034PubMedGoogle Scholar
  55. Wokke JHJ, de Koning J, Stanek G, Jennekens FGI (1987b) Chronic muscle weakness by Borrelia burgdorferi meningoradiculitis. Ann Neurol 22:389–392PubMedCrossRefGoogle Scholar
  56. Wokke JHJ, van Doom PA, Brand A, Schreuder GMT, Vermeulen M (1988) Association of HLA-DR antigen with serum I antibodies against Borrelia burgdorferi in Bannwarth’s syndrome. J Neurol 235:415–417PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • R. Martin
  • W. Kohlhepp
  • H. G. Mertens

There are no affiliations available

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