Neurological Lyme disease (Neuroborreliosis)

The Australian experience is that of major involvement of the cranial nerves. Lyme Disease Australia.

An overview would show

	1 some
	2 few
	3 4 and 6 several
	5 several including taste
	7 several
	8 very common, to the point where hypersensitivity to loud sound is almost pathognomic
	9 10 11 12 this group has the highest incidence of involvement in the patients to date which is not reported in the US nor Europe

This is a very different presentation to both American and European Lyme

Lets see if we can start an analysis of what is going on. This will take time and I will append information here as it comes to hand

1. Investigations - a look at imaging

I have been given to understand SPECT analysis is more helpful than MRI. Lets start with:

From the Canadian Lyme Disease foundation http://www.canlyme.com/fallonreview.html
MRI At the beginning under the heading Structural Brain imaging for
MRI scans among patients with neurologic Lyme disease may demonstrate punctate white matter lesions on T2-weighted images, similar to those seen in demyelinating or inflammatory disorders such as multiple sclerosis, systemic lupus erythematosus, or cerebrovascular disease

Further down under Functional brain imaging
SPECT has recently been reported to be a useful tool in the evaluation of patients with Lyme disease, showing multifocal areas of decreased perfusion in both the cortex and the subcortical white matter.

And The American Society of Neuroradiology http://www.ajnr.org/cgi/content/full/30/6/1079 
Under the CNS LNB heading search within for Single-photon emission CT may provide indirect manifestations of LNB antibiotic-reversible frontal hypoperfusion.^65,76,77. Of importance here is the demonstration of discrete microvascular lesions of hypoperfusion. We also now know it is not just the frontal lobe that can be affected. The essential lesion is parenchymal vascular and perivascular inflammation, which is not well presented in this paper, but more on that later.

These substantiate the above impression regarding the involvement of Cranials 9 10 11 and 12 as not being prevalent overseas. This could be nothing more than a climate factor, as living in a warm climate we are dressed in loose light clothing more often. Ticks migrate to the top of the host and what Australian doesn't know the back of the head and neck is a frequent site. Some months ago I saw a patient with several tick bites around her waist. They had attached at the waist line being prevented from further migration by the elastic of a waist petticoat.

Here is the report of a Spect scan on a practice patient of Dr Mayne diagnosed with Lyme Neuroborreliosis. This is a man hospitalised for 2 weeks initially with a left hemiparesis believed to be a TIA and only one month after the onset of his entire symptom complex, but this diagnosis was downgraded to "viral". This scan was done 3 months after the event and beautifully demonstrates the propensity to vascular episodes with the disease
Technique: Cerebral SPECT was performed after IV injection of Tc-ECD (neurolite) in a dimly lit room in a state of visual and aural hypostimulation. 
Findings: There is mild decrease of tracer activity in the right temporal-parietal region in the distribution of the right middle cerebral artery. No significant abnormalities are seen in the cerebellum Tracer distribution remains patchy in the rest of the cerebral cortices.
Conclusion: The mildly decreased tracer activity at the right temporal- parietal region in the distribution of the right middle cerebral artery is consistent with previous cerebral vascular event. No perfusion abnormalities are seen in the cerebellum.

2. Lyme Dementia

The above MRI and SPECT findings are early signs of extending parenchymal vascular inflammation that can lead on to multiple small vessel and later large vessel disease in the brain and subsequent dementia. A careful analysis of this scholarly material will demonstrate that as Syphilis was the cause of many confounding cases of dementia of varying type 100 years ago, it would appear Lyme will be the 21st century's equivalent unless the disease is detected and treated early enough. Viz: http://www.miklossy.ch/media/ChapterHandbookClinNeurolFinalPdf.pdf

Courtesy of Robert C. Bransfield MD this article shows photos of SPECT changes after 9 months ceftriaxone IV
Please follow this link for the full article

Here are the scans

 

3. Lyme Neuropsychiatric Disease

Here is an objective detailed assessment of the problem. Bear in mind the longer a person has infection the higher the chances and degree of brain infection. Viz: http://www.angelfire.com/biz/romarkaraoke/lymeart.html

4. Bands on western blot

It is known at Igenex that band 31 is found in neurological lyme. In addition band 58 may signify Garinii in Australia and this infection is known to cause neurological disease

More>

to come