Rare manifestations of lyme neuroborreliosis

Abstract

Lyme disease is an endemic infection in many European countries and Russia, including North-West region. Neurological manifestations are reported in about 10%-25% of patients. Lyme neuroborreliosis (LNB) can includes polyradiculoneuritis, meningoradiculitis, meningitis and encephalitis in adults. Two cases of LNB are presented. Patient one: a 46-yrs old man was admitted with a history of dizziness, fever and walking disorder after four months of fishing in endemic ( tick-borne infections) area. On examination patient showed dysarthria, ataxia and hemianopsia. CSF showed mild pleocytosis and elevated total protein. Serological methods (including Western blot test) were positive for LNB. Brain MRI showed subacute ischemic lesions on T2-weighted and T2-FLAIR images on vertebrobasilar territory. Patient two was a 52-yrs old man, hospitalized with general stiffness after two months after tick bite without erythema migrans and fever. Neurological examination revealed a dysarthria, bradykinesia and right sided rigidity. Serological studies were positive for LNB. The CSF total protein content was 0,89 g/l. MRI images showed multifocal lesions of white matter (demyelination, typically seen in inflammatory). Both patients were diagnosed and treated successfully for LNB: they received a 21-day course of 2 g per day ceftriaxone, then benzathine benzylpenicillin every 14 days for 3 months and every 28 days for another 3 months. Corticosteroids and platelet aggregation inhibitors in case one and dopaminergic medications (case two) were also prescribed. A year after treatment patients were free of neurological symptoms. The cases suggest that LNB can manifest rare clinical forms as cerebral vasculitis and parkinsonism.