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[Borrelian meningoencephalomyelitis. A case].

P Benoit1, E Dournon, M Masingue

  • 1Service de Clinique neurologique, CHU de Lille.

Presse Medicale (Paris, France : 1983)
|October 24, 1987
PubMed
Summary
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A severe case of central nervous system (CNS) impairment caused by Borrelia burgdorferi, a bacterium, presented with spastic paraparesis and cerebellar syndrome. Prompt treatment with antibiotics and corticosteroids led to significant improvement, highlighting effective therapeutic strategies for neuroborreliosis.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Immunology

Background:

  • Neuroborreliosis, a manifestation of Lyme disease, can present with diverse neurological symptoms.
  • Early diagnosis and treatment are crucial for managing central nervous system (CNS) involvement by Borrelia burgdorferi.

Observation:

  • A 22-year-old male presented with spastic paraparesis and cerebellar syndrome, accompanied by cerebrospinal fluid (CSF) abnormalities including lymphocytosis, elevated protein, hypoglycorachia, hypochlorurachia, and oligoclonal banding.
  • Extensive investigations ruled out other infectious and inflammatory causes, while high titers of anti-Borrelia burgdorferi antibodies in blood and CSF confirmed the diagnosis.
  • Cranial imaging (CT and MRI) revealed no abnormalities.

Findings:

  • Treatment with high-dose penicillin G followed by latamoxef, along with prednisone, resulted in the resolution of cerebellar signs, improvement in paraparesis, and normalization of CSF parameters.

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  • A significant decrease in both blood and CSF anti-Borrelia antibody levels was observed post-treatment.

    • Implications:

    • This case underscores the potential for severe CNS impairment by Borrelia burgdorferi and the efficacy of combined antibiotic and corticosteroid therapy.
    • The findings suggest that borrelian meningoencephalomyelitis may represent a tertiary stage of Lyme disease, analogous to syphilis.
    • Optimal treatment strategies for neuroborreliosis, though sometimes challenging, involve specific antibiotics and potentially corticosteroids.