Original Investigations

Journal of Neurology

, Volume 234, Issue 1, pp 40-43

First online:

Chronic progressive neurological involvement in Borrelia burgdorferi infection

  • B. WederAffiliated withKlinik für Neurologie, Kantonsspital
  • , P. WiedersheimAffiliated withKlinik für Neurologie, Kantonsspital
  • , L. MatterAffiliated withInstitut für klinische Mikrobiologie und Immunologie
  • , A. SteckAffiliated withService de neurologie, Centre Hospitalier Universitaire Vaudois
  • , F. OttoAffiliated withNeurologische Abteilung, St. Gallische Höhenklinik

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Summary

Five patients with chronic meningitis were hospitalized several times for progressive neurological symptoms. The clinical manifestations included cranial neuritis, radiculoneuritis, myelitis and encephalitis. In two cases cerebral infarction occurred. The course was commonly characterized by a tendency to deteriorate. From the clinical point of view, it was repeatedly difficult to exclude multiple sclerosis or tuberculous meningitis. Finally, specific antibodies against Borrelia burgdorferi were detected by indirect immunofluorescence assay. The diagnosis of a borreliosis was not considered initially because there was no history of tick-bite or erythema chronicum migrans, and the neurological involvement of the central nervous system seemed unusual. The latency between the first symptoms and diagnosis varied from 3 months to 5 years. After a parenteral, high-dose therapy with penicillin, there was a significant improvement in all patients. In two cases, there was evidence of intrathecally produced antibodies to myelin basic protein.

Key words

Borrelia burgdorferi infection Chronic meningitis Progressive course CNS involvement