Skip to main content

Advertisement

SpringerLink
Log in

Lyme disease of the brainstem

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Lyme disease is a multisystem infectious disease caused by the tick-borne spirochete, Borrelia burgdorferi. Central nervous system (CNS) involvement typically causes local inflammation, most commonly meningitis, but rarely parenchymal brain involvement. We describe a patient who presented with clinical findings suggesting a brainstem process. Magnetic resonance imaging (MRI) and positron emission tomography (PET) suggested a brainstem neoplasm. Prior to biopsy, laboratory evaluation led to the diagnosis of Lyme disease. Clinical and imaging abnormalities improved markedly following antimicrobial therapy. We describe Lyme disease involvement of the cerebellar peduncles with hypermetabolism on PET. Although MRI is the primary imaging modality for most suspected CNS pathology, the practical applications of PET continue to expand.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Halperin JJ, Volkman DH, Wu P (1991) Central nervous system abnormalities in Lyme neuroborreliosis. Neurology 41:1571–1582

    PubMed  Google Scholar 

  2. Halperin J, Lorgigian E, Finkel M, Pearl R (1996) Practice parameters for the diagnosis of patients with nervous sytem Lyme borreliosis (Lyme disease). Neurology 46:619–627

    PubMed  Google Scholar 

  3. Reik L, Steere AC, Bartenhagen NH, Shope RE, Malawista SE (1979) Neurologic abnormalities of Lyme disease. Medicine 58(4):281–294

    PubMed  Google Scholar 

  4. Broderick JP, Sandok BA, Mertz LE (1987) Focal encephalitis in a young woman 6 years after the onset of Lyme disease. Mayo Clin Proc 62:313–316

    PubMed  Google Scholar 

  5. Halperin JJ, Luft BJ, Anand AK et al (1989) Lyme neuroborreliosis: central nervous system manifestations. Neurology 39(6):753–759

    PubMed  Google Scholar 

  6. Chancellor MB, McGinnis DE, Shenot PJ, Hirsh IJ, Kiiholma PJ (1992) Lyme neuroborreliosis manifesting as an intracranial mass lesion. Neurosurgery 30(5):759–773

    Google Scholar 

  7. Murray R, Morawetz R, Kepes J et al (1992) Lyme neuroborreliosis manifesting as an intracranial mass lesion. Neurosurgery 5:769–773

    Google Scholar 

  8. Oksi J, Kalimo H, Marttila RJ et al (1996) Inflammatory brain changes in Lyme borreliosis. A report on three patients and review of literature. Brain 119:2143–2154

    PubMed  Google Scholar 

  9. Curless RG, Schatz NJ, Bowen BC, Rodriguez Z, Ruiz A (1996) Lyme neuroborreliosis masquerading as a brainstem tumor in a 15-year-old. Pediatr Neurol 15(3):258–260

    Article  PubMed  Google Scholar 

  10. Wormser GP, Nadelman RB, Dattwyler RJ et al (2000) Practice guidelines for the treatment of Lyme disease. The Infectious Diseases Society of America. Clin Infect Dis 31 Suppl 1(2):1–14

    Article  Google Scholar 

  11. Launes J, Siren J, Valanne L et al (1997) Unilateral hyperperfusion in brain perfusion SPECT predicts poor prognosis in acute encephalitis. Neurology 48:1347–1351

    PubMed  Google Scholar 

  12. Kawabe J, Okamura T, Shakudo M et al (2001) Physiological FDG uptake in the palatine tonsils. Ann Nucl Med 15(3):297–230

    PubMed  Google Scholar 

  13. Logigian EL, Johnson KA, Kijewski MF et al (1997) Reversible cerebral hypoperfusion in Lyme encephalopathy. Neurology 49(6):1661–1670

    PubMed  Google Scholar 

  14. Sumiya H, Kobayashi K, Mizukoshi C et al (1997) Brain perfusion SPECT in Lyme neuroborreliosis. J Nucl Med 38(7):1120–1122

    PubMed  Google Scholar 

  15. Newberg A, Hassan A, Alavi A (2002) Cerebral metabolic changes associated with Lyme disease. Nucl Med Commun 23(8):773–777

    Article  PubMed  Google Scholar 

  16. Halperin JJ (2002) Clinical features, diagnosis and therapy of neuroborreliosis. Vector Borne Zoonotic Dis 2:241–247

    Article  PubMed  Google Scholar 

  17. Paulesu E, Perani D, Fazio F (1996) Functional basis of memory impairment in multiple sclerosis: [18f] FDG PET study. Neuroimage 4:87–96

    Google Scholar 

  18. Sun X, Tanaka M, Kondo S, Okamoto K, Hirai S (1998) Clinical significance of reduced cerebral metabolism in multiple sclerosis; a combined PET and MRI study. Ann Nucl Med 12:89–94

    PubMed  Google Scholar 

  19. Bakshi R MR, Kinkel PR, Emmet ML, Kinkel WR (1998) High-resolution fluorodeoxyglucose positron emission tomography shows both global and regional cerebral hypometabolism in multiple sclerosis. J Neuroimaging 8:228–234

    PubMed  Google Scholar 

Download references

Acknowledgement

We thank Ronald Van Heertum, MD for providing the PET images.

Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA

    Peter Kalina

  2. Department of Neurology, Northern Westchester Hospital Center, Mt. Kisco, NY, 10549, USA

    Andrew Decker

  3. Division of Neurosurgery, Northern Westchester Hospital Center, Mt. Kisco, NY, 10549, USA

    Ezriel Kornel

  4. Department of Neurology, North Shore University Hospital, Manhasset, NY, 11030, USA

    John J. Halperin

Authors
  1. Peter Kalina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Decker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ezriel Kornel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John J. Halperin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Kalina.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kalina, P., Decker, A., Kornel, E. et al. Lyme disease of the brainstem. Neuroradiology 47, 903–907 (2005). https://doi.org/10.1007/s00234-005-1440-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-005-1440-2

Keywords

Search

Navigation