Chronic neuroborreliosis with pseudotumor cerebri (clinical case, discussion)

Authors

  • K.A. Taryanyk Poltava State Medical University, Poltava, Ukraine, Ukraine
  • M.Yu. Delva Poltava State Medical University, Poltava, Ukraine, Ukraine
  • T.Y. Purdenko Poltava State Medical University, Poltava, Ukraine, Ukraine
  • L.A. Samarchenko Poltava State Medical University, Poltava, Ukraine, Ukraine

DOI:

https://doi.org/10.22141/2224-0713.17.6.2021.242237

Keywords:

Lyme disease, pseudotumor cerebri

Abstract

The article describes a clinical case of chronic neuroborreliosis in form of cerebral pseudotumor syndrome in a 30-year-old patient. The patient complained of dizziness, double vision, decreased visual acuity in both eyes, a feeling of “fog before the eyes”, constant headache (7–8 points on a visual analog scale), sleep disturbances. During last summer (5–6 months before disease onset), there were repeated tick bites with skin redness, the patient did not seek medical help. The disease started 1.5 months ago in form of a headache; one month ago vision began to decrease and diplopia appeared. In the neurological status: left abductor nerve palsy. Brain MRI: empty sella turcica, flattening of the posterior scleras, optic nerves tortuosity. Ophthalmologist: visual acuity of the right eye — 0.3, left eye — 0.8, optic disc swelling of both eyes. Cerebrospinal fluid analysis: the pressure of 300 mm Hg (lumbar puncture in supine position), proteins — 0.198 g/l, cytosis — 5 in 1 ml (lymphocytes), anti-borreliosis IgG — 38.15 U/ml,
IgM — 5.61 U/ml. Immediately after the lumbar puncture, the patient noted a significant reduction in headache and diplopia. Cerebrospinal fluid-serum index for anti-borreliosis IgG — 1.2. Diagnosis: chronic neuroborreliosis with cerebral pseudotumor syndrome, left abductor nerve palsy, and visual impairments. Treatment: ceftriaxone, rheosorbilact, citicoline, acetazolamide, melatonin, phenibut. The patient refused repeated lumbar punctures. During hospital treatment, the patient’s condition improved: headaches decreased (to 3–4 points on the visual analog scale), diplopia disappeared, left eyeball movements fully restored, optic disc swelling diminished. Three months later, the patient by phone reported no complaints except for vision impairments. Thus, in patients with cerebral pseudotumor syndrome, among the potential etiological factors Lyme disease should be also excluded.

References

Koedel U., Fingerle V., Pfister HW. Lyme neuroborreliosis — epidemiology, diagnosis and management. Nat. Rev. Neur. 2015. 11(8). 446-456.

Oschmann P., Dorndorf W., Hornig C., Schäfer C., Wellensiek H.J., Pflughaupt K.W. Stages and syndromes of neuroborreliosis. J. Neurol. 1998. 245(5). 262-272.

Halperin J. Lyme neuroborreliosis. Curr. Opin. Infect. Dis. 2019. 32(3). 259-264.

Pfister H.W., Rupprecht T.A. Clinical aspects of neuroborreliosis and post-Lyme disease syndrome in adult patients. Int. J. Med. Microbiol. 2006. 296(40). 11-16.

Schwenkenbecher P., Pul R., Wurster U., Conzen J., Pars K., Hartmann H., Skripuletz T. Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization. BMC Infect. Dis. 2017. 17(1). 90.

Friedman D.I., Jacobson D.M. Diagnostic criteria for idiopathic intracranial hypertension. Neurology. 2002. 59. 1492-1495.

Delen F., Peker E., Onay M., Altay Ç.M., Tekeli O., Togay Işıkay C. The significance and reliability of imaging findings in pseudotumor cerebri. NeuroOphthalmology. 2019. 43(2). 81-90.

McGeeney B.E., Friedman D.I. Pseudotumor cerebri pathophysiology. Headache: The Journal of Head and Face Pain. 2014. 54(3). 445-458.

Degnan A.J., Levy L.M. Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. Am. J. Neuroradiol. 2011. 32(11). 1986-1993.

Raucher H.S., Kaufman D.M., Goldfarb J., Jacobson R.I., Roseman B., Wolff R.R. Pseudotumor cerebri and Lyme disease: a new association. J. Pediatr. 1985. 107. 931-933.

Belman A.L., Iyer M., Coyle P., Dattwyler R. Neurologic manifestations in children with North American Lyme disease. Neurology. 1993. 43. 2609-2614.

Bachman D.T., Srivastava G. Emergency department presentations of Lyme disease in children. Pediatr. Emerg. Care. 1998. 14. 356-361.

Kan L., Sood S.K., Maytal J. Pseudotumor cerebri in Lyme disease: a case report and literature review. Pediatr. Neurol. 1998. 18. 439-441.

Şahin B., İncecik F., Hergüner Ö.M. A presentation of Lyme disease: pseudotumor cerebri. Turk. J. Pediatr. 2015. 57. 522-524.

May K., Upadhyayula S. Papilledema as the sole manifestation of neuroborreliosis. Case Rep. Infect. Dis. 2021. 30. 2021.

Nørreslet Gimsing L., Lunde Larsen L.S. A rare case of pseudotumor cerebri in adult Lyme disease. Clin. Case Rep. 2020. 8(1). 116-119.

Castaldo J.E., Griffith E., Monkowski D.H. Pseudotumor cerebri: early manifestation of adult Lyme disease. Am. J. Med. 2008. 121. 5-6.

Garcia-Monco J.C., Coleman J.L., Benach J.L. Antibodies to myelin basic protein in Lyme disease. J. Infect. Dis. 1988. 158. 667-668.

Aberer E., Brunner C., Suckanek G. Molecular mimicry and Lyme borreliosis: A shared antigenic determinant between Borrelia burgdorferi and human tissue. Ann. Neurol. 1989. 26. 732-737.

Pachner A.R., Steiner I. Lyme neuroborreliosis: infection, immunity, and inflammation. Lancet Neurol. 2007. 6. 544-552

Raucher H.S., Kaufman D.M., Goldfarb J., Jacobson R.I., Roseman B., Wolff R.R. Pseudotumor cerebri and Lyme disease: a new association. J. Pediatr. 1985. 107(6). 931-933.

Ramgopal S., Obeid R., Zuccoli G., Cleves-Bayon C., No-walk A. Lyme disease-related intracranial hypertension in children: clinical and imaging findings. J. Neurol. 2016. 263(3). 500-507.

Published

2021-11-23

Issue

Section

To practicing Neurologist