Delayed resolution of white matter changes following therapy of B burgdorferi encephalitis

Abstract

Inflammatory involvement of the brain parenchyma or spinal cord is a rare finding in late stage borreliosis.1,2 We present a patient with severe Borrelia burgdorferi encephalitis and an unusual pattern of symmetric white matter changes with protracted resolution following antibiotic treatment. A 69-year-old woman presented with rapidly progressing dementia, gait disturbance, and bladder dysfunction over the course of 1 year. There was a remote history of tick bites several years earlier. No rash or erythema migrans, arthritis, facial paresis, or other sign of early or late-stage borreliosis had been noted. At presentation the patient was disoriented and her short-term memory was severely impaired. She was not able to stand unaided. There was ataxia of the limbs and a slight weakness of the legs. The deep tendon reflexes were exaggerated and there was a bilateral Babinski sign. The MRI findings at presentation and on follow-up visits are shown in the figure. Figure. Axial fluid-attenuated inversion recovery MRI at initial presentation and after 5 months and 5 years of follow-up at the levels of the cella media (upper row), basal ganglia (middle row), and mesencephalon (lower row). Note that …