Brain, Vol. 119, No. 6, 2143-2154, 1996
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research-article |
Inflammatory brain changes in Lyme borreliosis
A report on three patients and review of literature
1Departments of Internal MedicineTurku University Central Hospital Turku, Finland 2Departments of Pathology, Turku University Central Hospital Turku, Finland 3Departments of Neurology, Turku University Central Hospital Turku, Finland 4Departments of Radiology, Turku University Central Hospital Turku, Finland 5Department of Medical Microbiology, Turku University Turku, Finland 6National Public Health Institute, Department in Turku Turku, Finland 7Turku Immunology Centre Turku, Finland
Correspondence to:
Correspondence to: J. Oksi, Turku University, Department of Medical Microbiology, Kiinamyllynkatu 13, FIN-20520 Turku, Finland
Despite a rapid increase in the number of patients with Lyme neuroborreliosis (LNB), its neuropathological aspects are poorly understood. The objective of this study was evaluation of neuropathological, microbiological, and magnetic resonance imaging (MRI) findings in three patients with the Borrelia burgdorferi infection and neurological disease from whom brain tissue specimens were available. Perivascular or vasculitic lymphocytic inflammation was detected in all specimens. Large areas of demyelination in periventricular white matter were detected histologically and by MRI in one patient. The disease had a fatal outcome in this patient. Brain MRI suggested malignancies in two patients before histopathological studies were carried out. One of these two patients was a child with sudden hemiparesis. Another was a 40-year-old man presenting with epileptic seizures and MRI-detected multifocal lesions, which disappeared after repeated courses of antibiotics. We conclude that cerebral lymphocytic vasculitis and multifocal encephalitis may be associated with B. burgdorferi infection. The presence of B. burgdorferi DNA in tissue samples from areas with inflammatory changes indicates that direct invasion of B. burgdorferi may be the pathogenetic mechanism for focal encephalitis in LNB.
Borrelia burgdorferi; Lyme disease; neuroborreliosis; neuropathology; vasculitis
Received April 30, 1996. Revised June 4, 1996. Accepted July 25, 1996.
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