BackgroundLyme neuroborreliosis (LNB) is a disease caused by spirochete Borrelia burgdorferi, involving the nervous system. It usually manifests as lymphocytic meningoradiculitis, but in rare cases, it can also lead to cerebrovascular complications. We aimed to perform a systematic review of all reported cases of LNB complicated by central nervous system vasculitis and stroke or transient ischemic attack (TIA).Materials and methodsWe conducted a systematic review of literature between May 1987 and December 2016 with patients who presented with cerebrovascular course of LNB.ResultsThis study included 88 patients with a median age of 46 years. The median interval from onset of symptoms suggesting Lyme disease to first symptoms of cerebrovascular manifestations of LNB was 3.5 months. The most common cerebrovascular manifestation of LNB was ischemic stroke (76.1%), followed by TIA (11.4%). The posterior circulation was affected alone in 37.8% of patients, the anterior circulation in 24.4% of patients, and in 37.8% of cases, posterior and anterior circulations were affected simultaneously. The most common affected vessels were middle cerebral artery—in 19 cases, basilar artery—in 17 cases, and anterior cerebral artery—in 16 cases. A good response to antibiotic treatment was achieved in the vast number of patients (75.3%). The overall mortality rate was 4.7%.ConclusionCerebral vasculitis and stroke due to LNB should be considered, especially in patients who live in or have come from areas with high prevalence of tick-borne diseases, as well as in those without cardiovascular risk factors, but with stroke-like symptoms of unknown cause.
This study examines corpus callosum pathology in children with spastic cerebral palsy aged 7 to 15 years and to investigates the relation between corpus callosum areas and clinical picture. Magnetic resonance images of 46 patients were reviewed prospectively. Twenty-two patients with cerebral palsy were age and gender matched with the control patients. The cerebral palsy group had a significantly smaller mean corpus callosum surface area than did the control group. The cerebral palsy group also had a significantly smaller mean internal skull surface area measurement than did the control group. The corpus callosum/internal skull surface area ratio was also smaller for those with cerebral palsy. Wechsler Intelligence Scale Verbal IQ scores were associated with the surface area of the corpus callosum in cerebral palsy patients. A significant relationship between corpus callosum surface area and IQ scores in children with cerebral palsy was found. A positive correlation between internal skull surface area and IQ scores in children with cerebral palsy was noted. A significant correlation between Apgar score and corpus callosum surface area in the cerebral palsy group was found. A negative correlation between corpus callosum surface area and the Gross Motor Function Classification System in patients with cerebral palsy was noted.
These results indicate that neuronal loss and gliosis in HIV-infected patients may be associated with impairment of energy metabolism. The spectral changes found suggest that 1H MRS can be used for early detection of brain damage induced by HIV.
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