Spirochete infections

• Boreliosis (Lyme disease)Borrelia burgdorferi

• Syphylis (Lues)Treponema pallidum

Borrelia burgdorferi

Summary of reported cases of Lyme disease in the United States.

Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079-1087

©2009 by American Society of Neuroradiology

Lyme disease

Lyme disease

Skin lesionAfter tick bite

Erythema migrans rash with the typical target appearance that is virtually diagnostic of Lyme disease.

Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079-1087

©2009 by American Society of Neuroradiology

Lyme disease

Clinical feature

• 10-15% patients with untreated borreliosis – neuroborelliosis

• Primary location – ganglia od posterior roots, nerv roots, leptomeninges (macacus rhesus)

• Europe –– B. garinii

Clinical feature Periferal NS

• Sensory symptoms

• Painful radiculitis

• Painful lymphocytic meningoradiculitis – with/without paresis (Garin-Bujadoux-Bannwart syndróm)

• Facial palsy

• Pain – sharp, during night, weeks – months

Clinical feature Central NS

• Subsequent to the tick bite inoculation – B. reach reach the CNS

• Hematogenously or retrogradely via periferal nerves

• Encefalitis• Cranial neuritis • Motor or sensitive radikuloneuroitis • Encefalomyelitis - rare

Clinical feature late presentation

• Dementia – often in patients with artritis Desorientation, confusion, memory problems, cognitive dysfunction

• Chronic radikuloneuropathy – parestesia of acral parts, pain,

• EMG – axonal lesion

Diagnosis

• EMG – axonal lesion

• CSF:

• pleocytosis – Ly, proteins intratecal antibodies IgM, IgG against BB

• PCR

Facial neuritis.

Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079-1087

©2009 by American Society of Neuroradiology

Evolving cranial neuritis. Enhancement n. III, V l.dx., VII l. sin.

Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079-1087

©2009 by American Society of Neuroradiology

A 50-year-old woman with a history of tick bite and erythema migrans rash treated with doxycycline, who had recurrent erythema migrans rash with

headache, fever, nausea, and nuchal rigidity.

Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079-1087

©2009 by American Society of Neuroradiology

A 74-year-old man with 2-year cognitive decline and memory loss.

Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079-1087

©2009 by American Society of Neuroradiology

A 56-year-old woman with neck, bilateral shoulder, and bilateral arm pain.

Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079-1087

©2009 by American Society of Neuroradiology

A 17-year-old boy with right papilledema and orbital pain and rule out pseudotumor.

Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079-1087

©2009 by American Society of Neuroradiology

Boreliosis

• Th: Doxycycline (2x100 mg/D, 2T) CSF negat.

• i.v. ceftriaxone – likvor pozit.

Syphilis (Lues)

•1/3 nontreated patients – neurovascular complications of syphylis

Neurosyphilis

• Patogenesis• Perivascular infiltration of the meninges, focal

meningeal inflammation – formation of hypertrophic meninges, or gumma,

• Inflammatory cells invide blood vessel wal – arteritis (luminal occlusion)

• Parenchymal involvement – gliosis in late stages• Ly infiltration of preganglionic portion of dorsal

roots and posterior columns atrophy of posterior columns

Neurosyfilis – meningitis

• CSF Ly, ↓ Glu, proteins

• Pozit. VDRL test

Neurosyfilis – meningovascular

• Endarteritis – small and medium vessels (MCA) – can be stroke etiology in young people !!!

• Focal signs

• AG: nerrowing of arteries

• MRI: multiple infarcts • Spinal artery – transversal myelitis

Demencia paralyticaProgressive paralysis

• Decreased cognitive functions, memory problems, pupils abnormality

Tabes dorsalis

• Paresthesias in root distribution

• Decreased proprioception

• Spinal ataxia• Argyll-Roberts pupils

Acquired immunodeficiency syndrom (AIDS) Human immunodeficiency virus (HIV)

• I. stage

• Acute infection - 2. - 3. weeks after infection by HIV

• Symptoms like flu, or mononukleosis

• Acute retroviral syndrom

Stage II

• Period without symptoms – 2-10 years or more

• Decreased imunity in this period

Stage III, IV

• III – generalized lymphadenopathy, enlargement of LN

• IV- stage of AIDS • Weakened immune system fails • Fewer, lost of weight, weakness, fatigue,

muscle atrophy

Acquired immunodeficiency syndrom (AIDS)

• IV stage - symptoms of lesion of PNS and CNS

• Aseptic meningitis

• Cognitive decline

• Myelopathy • Neuropathy (inflammatory demyelinating

polyneuropathy, mononeuropathy, plexopathy)

• Myopathy – myositis

AIDS dementia complex (ADC)

• T2- MRI:

• Enlargement of ventricles

• Hyperintensity in subcortical white matter of frontal lobes

• Brain atrophy

HIV Opportunistic Infections

• People with advanced HIV infection are vulnerable to infections and malignancies that are called 'opportunistic infections' because they take advantage of the opportunity offered by a weakened immune system.

• Bacterial diseases such as tuberculosis, Mycobacterium avium complex, bacterial pneumonia and septicaemia (blood poisoning)

• Protozoal diseases such as toxoplasmosis, microsporidiosis, cryptosporidiosis, isopsoriasis and leishmaniasis

HIV Opportunistic Infections

• Fungal diseases such as Pneumocystis pneumonia, candidiasis, cryptococcosis and penicilliosis

• Viral diseases such as those caused by cytomegalovirus, herpes simplex and herpes zoster virus

• HIV-associated malignancies such as Kaposi's sarcoma, lymphoma and squamous cell carcinoma.