Reversible corticospinal tract hyperintensities in neurologic Lyme disease
Estelle Pruvost-Robieux, Jennifer Yeung, MD, Veronica Sudacevschi, MD, Yves Cordoliani, MD, Maxime De Malherbe, MD and Fernando Pico, MD, PhD
From Versailles Hospital (E.P.-R., J.Y., V.S., M.D.M., F.P.); and Parly 2 Clinic (Y.C.), Le Chesnay, France.
Neurology August 2, 2016 vol. 87 no. 5 548-549
A 60-year-old man presented with an ataxic and spastic gait with paraparesis, having reported a tick bite. Brain MRI depicted bilateral corticospinal tract hyperintensities (figure). He had a mild lymphocytic meningitis (12 leukocytes/mm3, proteinorachia 1.48 g/L). ELISA was positive for Lyme disease in serum (immunoglobulin G [IgG] 176 UI and immunoglobulin M <4 UI) and CSF (IgG 300 UI) with an intrathecal synthesis (index of CSF/serum-specific antibodies equal to 16 using ELISA [normal value <1.5]). Western blot was positive for Lyme-specific antibodies in serum (18, 22, 32, 41, 60, and 75 kDa) and CSF (41 and 60 kDa). Syphilis serology was negative. After treatment (IV ceftriaxone 2 g daily for 4 weeks), gait improved and brain MRI was normal. This MRI pattern has been previously reported in amyotrophic lateral sclerosis1 and in metabolic diseases (Krabbe disease,2 X-linked adrenoleukodystrophy, cerebrotendinous xanthomatosis) or infectious diseases (human T-cell lymphotropic virus 1).
Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
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