Abstract
A 54-year-old female living in Europe presented with gait ataxia, dizziness, and bilateral hearing loss. Magnetic resonance imaging (MRI) revealed non-specific white matter changes. The patient’s condition gradually deteriorated over two years without diagnosis. The patient continued to decline cognitively and neurologically with worsening ataxia and upper motor neuron signs. Repeat MRI showed worsening white matter changes. Lumbar puncture, not previously done, showed positive Lyme testing. Treatment with intravenous ceftriaxone resulted in marked neurological improvement. Four years after symptom, the patient has short-term memory deficits and chronic fatigue, but is otherwise neurologically, cognitively, and functionally intact. Follow up MRI findings remain largely unchanged. Because cases of intraparenchymal or encephalopathic neuroborreliosis in America are lacking, so are treatment options. We present a rare case and discuss our experience with antibiotic treatment. This case lends evidence to define optimal treatment of this disease, imperative for hastening neurological recovery.
Highlights
G (MRI) revealed non-specific white matter n changes
This could explain the fact that reports of neuroborreliosis reported in the US are rare, especially in the adult population
The present case describes a patient with chronic Lyme neuroborreliosis; potentially adding much-needed evidence on effective management of this rare but serious disease
Summary
A 54-year-old Caucasian female with past medical history of uncomplicated migraines first noticed dizziness and ataxic gait in April 2009. The woman, American by nationality, was living with her husband in the Netherlands at the time Thereafter, she developed bilateral hearing loss and noticed a 20-pound unintentional weight loss over the previous couple months. 2014 Licensee PAGEPress, Italy Infectious Disease Reports 2014; 6:5496 doi:10.4081/idr.2014.5696 tiform activity Her workup was otherwise unrevealing; it included complete blood count, basic metabolic panel, creatine phosphokinase, lactate, echocardiogram with bubble study, chest radiograph, vasculitis and hypercoagulable profiles. After her antibiotic course, California encephalitis serology, CSF. Follow up brain MRI showed slight decrease in size of the pontine and cerebellar peduncular lesions, but otherwise no changes (Figure 2)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
