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Related Experiment Videos

Reversible cerebral hypoperfusion in Lyme encephalopathy

E L Logigian1, K A Johnson, M F Kijewski

  • 1Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA.

Neurology
|December 31, 1997
PubMed
Summary

Quantitative SPECT imaging reveals reduced cerebral blood flow in Lyme encephalopathy (LE) patients, particularly in frontal regions. This hypoperfusion partially improves after antibiotic treatment, but SPECT alone cannot diagnose LE.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Lyme encephalopathy (LE) causes subtle neuropsychiatric symptoms months to years post-Borrelia burgdorferi infection.
  • Standard brain MRI is typically normal in LE patients.
  • Diagnostic and therapeutic monitoring methods for LE require further investigation.

Purpose of the Study:

  • To evaluate quantitative single photon emission computed tomography (SPECT) for diagnosing LE.
  • To assess SPECT's utility in measuring treatment response to antibiotics.
  • To determine the neuroanatomic basis of LE using SPECT.

Main Methods:

  • Quantitative SPECT imaging was performed on 13 patients with confirmed LE and 9 with possible LE.
  • Cerebral perfusion was assessed using the perfusion defect index (PDI).

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  • SPECT scans were repeated after 6 months of intravenous ceftriaxone treatment in LE patients.

    • Main Results:

    • LE patients exhibited significantly reduced cerebral perfusion (mean PDI = 255) compared to normal subjects (mean PDI = 136), especially in frontal subcortical and cortical areas.
    • Ceftriaxone treatment led to significant improvement in perfusion (mean PDI = 188) in LE patients.
    • Possible LE patients showed similar perfusion deficits to LE patients, with many having prior antibiotic exposure.

    Conclusions:

    • Lyme encephalopathy is associated with hypoperfusion in frontal subcortical and cortical regions.
    • Cerebral perfusion deficits in LE patients are partially reversible with ceftriaxone therapy.
    • Quantitative SPECT imaging, while showing treatment response, is insufficient for standalone LE diagnosis or confirmation of active CNS infection.