title: A case of chronic progressive lyme encephalitis as a manifestation of late lyme neuroborreliosis.
abstract: A 54-year-old female living in Europe presented with gait ataxia, dizziness, and bilateral hearing loss. Magnetic resonance imaging (MRI) revealed non-specific white matter changes. The patient's condition gradually deteriorated over two years without diagnosis. The patient continued to decline cognitively and neurologically with worsening ataxia and upper motor neuron signs. Repeat MRI showed worsening white matter changes. Lumbar puncture, not previously done, showed positive Lyme testing. Treatment with intravenous ceftriaxone resulted in marked neurological improvement. Four years after symptom, the patient has short-term memory deficits and chronic fatigue, but is otherwise neurologically, cognitively, and functionally intact. Follow up MRI findings remain largely unchanged. Because cases of intraparenchymal or encephalopathic neuroborreliosis in America are lacking, so are treatment options. We present a rare case and discuss our experience with antibiotic treatment. This case lends evidence to define optimal treatment of this disease, imperative for hastening neurological recovery.
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center , PA, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Verma
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center , PA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Roman
authors.affiliation: Division of Neurology, University of Pittsburgh Medical Center , PA, USA.
authors.forename: Disha
authors.initials: D
authors.lastname: Shah
authors.affiliation: Division of Neurology, University of Pittsburgh Medical Center , PA, USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Zaretskaya
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center , PA, USA ; Division of Infectious Diseases, University of Pittsburgh Medical Center , PA, USA.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Yassin
keywords: Borrelia burgdorferi; Lyme neuroborreliosis; encephalopathy