title: Central nervous system manifestations of Lyme disease.
abstract: We studied six patients with central nervous system manifestations of Lyme disease. Weeks to years after the initial infection, behavioral changes, ataxia, and/or weakness in bulbar or peripheral muscles developed. Four of the six patients had a lymphocytic pleocytosis in the cerebrospinal fluid, and two of them had magnetic resonance imaging scans suggestive of demyelination. In a patient with a subacute encephalitis, a brain biopsy specimen showed microgliosis without an inflammatory infiltrate and spirochetes morphologically compatible with Borrelia burgdorferi. All six patients had elevated antibody titers to B burgdorferi in serum, but none had selective concentration of specific antibody in the cerebrospinal fluid. All six patients were treated with high-dose intravenous penicillin; four had complete recoveries and two did not. Lyme disease may affect the central nervous system causing organic brain disease or syndromes suggestive of demyelination.
authors.affiliation: Department of Neurology, Georgetown University School of Medicine, Washington, DC.
authors.forename: A R
authors.initials: AR
authors.lastname: Pachner
authors.forename: P
authors.initials: P
authors.lastname: Duray
authors.forename: A C
authors.initials: AC
authors.lastname: Steere
mesh_terms: D000328:Adult; D002493:Central Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged