Skip to main content
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2000 Jul;83(1):67–71. doi: 10.1136/adc.83.1.67

Primarily chronic and cerebrovascular course of Lyme neuroborreliosis: case reports and literature review

M Wilke 1, H Eiffert 1, H Christen 1, F Hanefeld 1
PMCID: PMC1718399  PMID: 10869004

Abstract

As part of an ongoing study aiming to define the clinical spectrum of neuroborreliosis in childhood, we have identified four patients with unusual clinical manifestations. Two patients suffered from a primarily chronic form of neuroborreliosis and displayed only non-specific symptoms. An 11 year old boy presented with long standing symptoms of severe weight loss and chronic headache, while the other patient had pre-existing mental and motor retardation and developed seizures and failure to thrive. Two further children who presented with acute hemiparesis as a result of cerebral ischaemic infarction had a cerebrovascular course of neuroborreliosis. One was a 15 year old girl; the other, a 5 year old boy, is to our knowledge the youngest patient described with this course of illness. Following adequate antibiotic treatment, all patients showed substantial improvement of their respective symptoms. Laboratory and magnetic resonance imaging findings as well as clinical course are discussed and the relevant literature is reviewed.



Full Text

The Full Text of this article is available as a PDF (151.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brower M. C., Rollins N., Roach E. S. Basal ganglia and thalamic infarction in children. Cause and clinical features. Arch Neurol. 1996 Dec;53(12):1252–1256. doi: 10.1001/archneur.1996.00550120060017. [DOI] [PubMed] [Google Scholar]
  2. Caekebeke J. F., Peters A. C., Vandvik B., Brouwer O. F., de Bakker H. M. Cerebral vasculopathy associated with primary varicella infection. Arch Neurol. 1990 Sep;47(9):1033–1035. doi: 10.1001/archneur.1990.00530090115023. [DOI] [PubMed] [Google Scholar]
  3. Christen H. J., Hanefeld F., Eiffert H., Thomssen R. Epidemiology and clinical manifestations of Lyme borreliosis in childhood. A prospective multicentre study with special regard to neuroborreliosis. Acta Paediatr Suppl. 1993 Feb;386:1–75. doi: 10.1111/j.1651-2227.1993.tb18082.x. [DOI] [PubMed] [Google Scholar]
  4. Dupuis M. J. Les multiples manifestations neurologiques des infections à Borrelia burgdorferi. Rev Neurol (Paris) 1988;144(12):765–775. [PubMed] [Google Scholar]
  5. Garcia-Monco J. C., Benach J. L. Lyme neuroborreliosis. Ann Neurol. 1995 Jun;37(6):691–702. doi: 10.1002/ana.410370602. [DOI] [PubMed] [Google Scholar]
  6. Garcia-Monco J. C. Pathomechanismen der Neuroborreliose. Wien Med Wochenschr. 1995;145(7-8):174–177. [PubMed] [Google Scholar]
  7. Grau A. J., Buggle F., Hacke W. Infektionskrankheiten als Ursache und Risikofaktor für zerebrovaskuläre Ischämien. Nervenarzt. 1996 Aug;67(8):639–649. doi: 10.1007/s001150050036. [DOI] [PubMed] [Google Scholar]
  8. Halperin J. J., Volkman D. J., Wu P. Central nervous system abnormalities in Lyme neuroborreliosis. Neurology. 1991 Oct;41(10):1571–1582. doi: 10.1212/wnl.41.10.1571. [DOI] [PubMed] [Google Scholar]
  9. Hansen K., Lebech A. M. The clinical and epidemiological profile of Lyme neuroborreliosis in Denmark 1985-1990. A prospective study of 187 patients with Borrelia burgdorferi specific intrathecal antibody production. Brain. 1992 Apr;115(Pt 2):399–423. doi: 10.1093/brain/115.2.399. [DOI] [PubMed] [Google Scholar]
  10. Hoffmann G. F., Surtees R. A., Wevers R. A. Cerebrospinal fluid investigations for neurometabolic disorders. Neuropediatrics. 1998 Apr;29(2):59–71. doi: 10.1055/s-2007-973538. [DOI] [PubMed] [Google Scholar]
  11. Kaiser R. Intrathecal immune response in patients with neuroborreliosis: specificity of antibodies for neuronal proteins. J Neurol. 1995 May;242(5):319–325. doi: 10.1007/BF00878875. [DOI] [PubMed] [Google Scholar]
  12. Kamholz J., Tremblay G. Chickenpox with delayed contralateral hemiparesis caused by cerebral angiitis. Ann Neurol. 1985 Sep;18(3):358–360. doi: 10.1002/ana.410180317. [DOI] [PubMed] [Google Scholar]
  13. Kleinschmidt-DeMasters B. K., Amlie-Lefond C., Gilden D. H. The patterns of varicella zoster virus encephalitis. Hum Pathol. 1996 Sep;27(9):927–938. doi: 10.1016/s0046-8177(96)90220-8. [DOI] [PubMed] [Google Scholar]
  14. Krüger H., Heim E., Schuknecht B., Scholz S. Acute and chronic neuroborreliosis with and without CNS involvement: a clinical, MRI, and HLA study of 27 cases. J Neurol. 1991 Aug;238(5):271–280. doi: 10.1007/BF00319739. [DOI] [PubMed] [Google Scholar]
  15. Lock G., Berger G., Gröbe H. Neuroborreliose: Progressive Encephalomyelitis mit cerebraler Vaskulitis. Monatsschr Kinderheilkd. 1989 Feb;137(2):101–104. [PubMed] [Google Scholar]
  16. Logigian E. L., Johnson K. A., Kijewski M. F., Kaplan R. F., Becker J. A., Jones K. J., Garada B. M., Holman B. L., Steere A. C. Reversible cerebral hypoperfusion in Lyme encephalopathy. Neurology. 1997 Dec;49(6):1661–1670. doi: 10.1212/wnl.49.6.1661. [DOI] [PubMed] [Google Scholar]
  17. Luxton R. W., Thompson E. J. Affinity distributions of antigen-specific IgG in patients with multiple sclerosis and in patients with viral encephalitis. J Immunol Methods. 1990 Aug 7;131(2):277–282. doi: 10.1016/0022-1759(90)90199-6. [DOI] [PubMed] [Google Scholar]
  18. Meier C., Grehl H. Vaskulitische Neuropathie bei Garin-Bujadoux-Bannwarth-Syndrom. Ein Beitrag zum Verständnis der Pathologie und Pathogenes neurologischer Komplikationen bei Lyme-Borreliose. Dtsch Med Wochenschr. 1988 Jan 29;113(4):135–138. doi: 10.1055/s-2008-1067607. [DOI] [PubMed] [Google Scholar]
  19. Millner M. Die Lyme-Borreliose im Kindesalter. Padiatr Padol. 1992;27(6):A81–A93. [PubMed] [Google Scholar]
  20. Moriarty J., Costa D. C., Schmitz B., Trimble M. R., Ell P. J., Robertson M. M. Brain perfusion abnormalities in Gilles de la Tourette's syndrome. Br J Psychiatry. 1995 Aug;167(2):249–254. doi: 10.1192/bjp.167.2.249. [DOI] [PubMed] [Google Scholar]
  21. Mourin S., Bonnier C., Bigaignon G., Lyon G. Epilepsie révélatrice d'une neuroborréliose. Rev Neurol (Paris) 1993;149(8-9):489–491. [PubMed] [Google Scholar]
  22. Nozoe S., Naruo T., Nakabeppu Y., Soejima Y., Nakajo M., Tanaka H. Changes in regional cerebral blood flow in patients with anorexia nervosa detected through single photon emission tomography imaging. Biol Psychiatry. 1993 Oct 15;34(8):578–580. doi: 10.1016/0006-3223(93)90205-r. [DOI] [PubMed] [Google Scholar]
  23. Oksi J., Kalimo H., Marttila R. J., Marjamäki M., Sonninen P., Nikoskelainen J., Viljanen M. K. Inflammatory brain changes in Lyme borreliosis. A report on three patients and review of literature. Brain. 1996 Dec;119(Pt 6):2143–2154. doi: 10.1093/brain/119.6.2143. [DOI] [PubMed] [Google Scholar]
  24. Oksi J., Kalimo H., Marttila R. J., Marjamäki M., Sonninen P., Nikoskelainen J., Viljanen M. K. Intracranial aneurysms in three patients with disseminated Lyme borreliosis: cause or chance association? J Neurol Neurosurg Psychiatry. 1998 May;64(5):636–642. doi: 10.1136/jnnp.64.5.636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Pradella S. P., Krause A., Müller A. Akute Borreliainfektion. Einseitige Papillitis als isolierte klinische Manifestation. Ophthalmologe. 1997 Aug;94(8):591–594. doi: 10.1007/s003470050165. [DOI] [PubMed] [Google Scholar]
  26. Reiber H., Lange P. Quantification of virus-specific antibodies in cerebrospinal fluid and serum: sensitive and specific detection of antibody synthesis in brain. Clin Chem. 1991 Jul;37(7):1153–1160. [PubMed] [Google Scholar]
  27. Schmutzhard E., Pfausler B., Gasse T., Hittmair-Delazer M., Benke T. Verlaufsformen und Folgezustände bei chronischer Neuroborreliose. Wien Med Wochenschr. 1995;145(7-8):183–186. [PubMed] [Google Scholar]
  28. Sigal L. H. Lyme disease: a review of aspects of its immunology and immunopathogenesis. Annu Rev Immunol. 1997;15:63–92. doi: 10.1146/annurev.immunol.15.1.63. [DOI] [PubMed] [Google Scholar]
  29. Sigal L. H. Persisting complaints attributed to chronic Lyme disease: possible mechanisms and implications for management. Am J Med. 1994 Apr;96(4):365–374. doi: 10.1016/0002-9343(94)90068-x. [DOI] [PubMed] [Google Scholar]
  30. Stanek G., O'Connell S., Cimmino M., Aberer E., Kristoferitsch W., Granström M., Guy E., Gray J. European Union Concerted Action on Risk Assessment in Lyme Borreliosis: clinical case definitions for Lyme borreliosis. Wien Klin Wochenschr. 1996 Dec 13;108(23):741–747. [PubMed] [Google Scholar]
  31. Vandvik B., Sköldenberg B., Forsgren M., Stiernstedt G., Jeansson S., Norrby E. Long-term persistence of intrathecal virus-specific antibody responses after herpes simplex virus encephalitis. J Neurol. 1985;231(6):307–312. doi: 10.1007/BF00313707. [DOI] [PubMed] [Google Scholar]
  32. Veenendaal-Hilbers J. A., Perquin W. V., Hoogland P. H., Doornbos L. Basal meningovasculitis and occlusion of the basilar artery in two cases of Borrelia burgdorferi infection. Neurology. 1988 Aug;38(8):1317–1319. doi: 10.1212/wnl.38.8.1317. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES