Lyme Encephalopathy

The patient was a 35 year old right- handed construction worker who was well until July 1979. At that time, he developed erythema migrans in association with flu-like symptoms. Four days later right facial palsy and fatigue developed, but resolved within one month. Five months later, in December, he developed oligoarticular arthritis affecting the knees which resolved spontaneously by 1983. In 1985, 6 years after onset of infection, the patient's wife noted that he had become very forgetful and was tending to fall asleep in the afternoons while on the job. There were no symptoms of another disease process, new medicines, or drug abuse to explain his symptoms. On examination at the bedside he appeared normal. However, on neuropsychological tests he had a markedly abnormal verbal memory despite a normal IQ. His spinal fluid showed no pleocytosis but had an elevated protein of 97 mg %. His serum Lyme titer was elevated, but more importantly, he had selective concentration of antibody in spinal fluid with a CSF/serum ratio of 1.3. MR of the brain and a polysomnogram were normal. He was treated with a one month course of IV ceftriaxone and gradually improved over 3-6 months with decrease in his spinal fluid protein from 97 to 70 to 52. Neuropsychologic tests improved but were still slightly abnormal at 6 months after therapy.

Perfusion SPECT shows multifocal abnormalities of perfusion largely affecting the frontal lobes and hemispheric white matter. MR is normal. After antibiotic therapy, the perfusion abnormalities improved. To see this best, use the "time" button.

Dr. Eric Logigian's brief review of this disorder is here.

Some details have been altered to protect confidentiality.
Keith A. Johnson (, J. Alex Becker (