title: Acute neuroborreliosis with involvement of the central nervous system.
abstract: BACKGROUND
  Lyme neuroborreliosis has not been previously reported in Taiwan. The purpose of this study was to describe the important characteristics of Lyme neuroborreliosis caused by Borrelia burgdorferi-like species in Taiwanese patients.
  
  
  METHODS
  Patients with acute neurological symptoms without a clear explanation during September 2005 to December 2008 were enrolled. All patients received extensive auxiliary investigations, including clinical evaluation by neurological examination, electrophysiological and neuroimaging studies, serological screening tests of serum and cerebrospinal fluid (CSF) by indirect immunofluorescent assay, and Western immunoblot analysis conducted for seroreactivities in serum and CSF of Borrelia burgdorferi-specific IgM and IgG antibodies.
  
  
  RESULTS
  Eleven patients who presented with acute central nervous system (CNS) syndrome fulfilled the diagnostic criteria for neuroborreliosis. In the CSF studies, lymphocytic pleocytosis with elevation of total protein and normal glucose was noted in 9 patients. The clinical syndromes were confirmed by magnetic resonance imaging and electrophysiological studies. Ten of 11 patients were found to have brain stem or spinal cord lesions on neuroimaging studies, and 8 patients had concomitant peripheral nervous system involvement with electrophysiological evidence of multiple root lesions with an acute or subacute course.
  
  
  CONCLUSIONS
  Lyme neuroborreliosis presenting as acute CNS syndrome with peripheral nervous system involvement simultaneously in the disease course, especially acute myelopolyradiculitis, in Taiwan is different from Lyme neuroborreliosis seen in Europe and North America. The treatment outcome is variable and based on the severity of initial neurological deficits, early diagnosis, and early management.
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, 199, Tung Hwa North Road, Taipei, Taiwan.
authors.forename: Bao-Luen
authors.initials: BL
authors.lastname: Chang
authors.forename: Chien-Ming
authors.initials: CM
authors.lastname: Shih
authors.forename: Long-Sun
authors.initials: LS
authors.lastname: Ro
authors.forename: Chin-Chang
authors.initials: CC
authors.lastname: Huang
authors.forename: Rong-Kuo
authors.initials: RK
authors.lastname: Lyu
authors.forename: Rou-Shayn
authors.initials: RS
authors.lastname: Chen
authors.forename: Jiann-Der
authors.initials: JD
authors.lastname: Lee
authors.forename: Li-Lian
authors.initials: LL
authors.lastname: Chao
authors.forename: Hung-Chou
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D025065:Borrelia burgdorferi / Q000302:isolation & purification / Q000472:pathogenicity; D001921:Brain / Q000382:microbiology / Q000473:pathology; D002493:Central Nervous System Diseases / Q000097:blood / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000276:immunology; D015331:Cohort Studies; D004576:Electromyography / Q000379:methods; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect / Q000379:methods; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000097:blood / Q000134:cerebrospinal fluid / Q000150:complications* / Q000276:immunology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009431:Neural Conduction / Q000502:physiology; D009460:Neurologic Examination / Q000379:methods; D012189:Retrospective Studies; D013116:Spinal Cord / Q000382:microbiology; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult