Abstract
Tick-borne infections—including tick-borne encephalitis viruses, represented in the
United States by rare infections with Powassan and deer tick viruses, and more often
Lyme disease—are of increasing importance to neurologists. Lyme neuroborreliosis (LNB)
causes all or part of a triad including meningitis, radiculoneuritis, and cranial
neuritis. Rarely, parenchymal brain and spinal cord involvement occur, with focal
findings on examination and magnetic resonance imaging (MRI). LNB diagnosis requires
plausible exposure, objective evidence of nervous system involvement, and, generally,
positive two-tier serology. Central nervous system (CNS) LNB is almost always accompanied
by abnormal cerebrospinal fluid (CSF) (cells, protein), often with intrathecal antibody
production, which is determined by concentration-adjusted comparison of serum and
CSF antibody. Measuring CSF antibody in isolation and nucleic acid-based testing of
CSF are not useful in LNB and should be avoided. LNB treatment is highly effective
with a 2- to 3-week course of antibiotics. Increasing evidence suggests that LNB not
involving the CNS parenchyma can be treated successfully with oral doxycycline.
Keywords
Lyme disease -
Borrelia burgdorferi
- neuroborreliosis - neurologic - nervous system - diagnosis - treatment - Powassan
-
Borrelia mayonii
-
Borrelia miyamotoi
