CT and MR neuroimaging findings in patients with Lyme neuroborreliosis: A national prospective cohort study

Ørbæk, Mathilde; Bodilsen, Jacob; Gynthersen, Rosa Maja Møhring; Shekhrajka, Nitesh; Nordberg, Cecilie Lerche; Petersen, Pelle Trier; Storgaard, Merete; Brandt, Christian; Wiese, Lothar; Hansen, Birthe; Lüttichau, Hans R.; Andersen, Aase Bengaard; Mens, Helene; Nielsen, Henrik; Lebech, Anne‐Mette

doi:10.1016/j.jns.2020.117176

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…13 Patients with longer duration of symptoms are more likely to have LNB findings on MRI, as in our cases. 12 However, there is frequently lack of correlation between enhancement of cranial nerves or nerve roots and neurologic symptoms, which was also seen in our three cases. 5,13,14 Due to diagnostic challenges, LNB is commonly associated with delays to presentation and treatment.…”

Section: Discussionmentioning

confidence: 47%

“…7 Imaging findings supportive of LNB include meningeal, leptomeningeal, or neural enhancement though prevalence of these findings varies. [11][12][13] A prospective cohort study of 368 Danish patients with LNB showed only 12%-14% of MRIs demonstrated findings of LNB, 12 but another prospective cohort study of 69 European LNB patients found 57% had cranial nerve enhancement. 13 Patients with longer duration of symptoms are more likely to have LNB findings on MRI, as in our cases.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series

Palmer,

Sokola,

Uysal

et al. 2024

The Neurohospitalist

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Lyme disease is a multisystem disorder transmitted through the Ixodes tick and is most commonly diagnosed in northeastern and mid-Atlantic states, Wisconsin, and Minnesota, though its disease borders are expanding in the setting of climate change. Approximately 10%–15% of untreated Lyme disease cases will develop neurologic manifestations of Lyme neuroborreliosis (LNB). Due to varying presentations, LNB presents diagnostic challenges and is associated with a delay to treatment. We discuss three cases of LNB admitted to our referral center in a traditionally low-incidence state to highlight clinical pearls in LNB diagnosis. Three patients from low-incidence areas with prior diagnostic evaluations presented in August with neurologic manifestations of radiculoneuritis, cranial neuropathies, and/or lymphocytic meningitis. MRI findings included cranial nerve, nerve root, and leptomeningeal enhancement leading to broad differential diagnoses. Lumbar puncture demonstrated lymphocytic pleocytosis (range 85-753 cells/uL) and elevated protein (87-318 mg/dL). Each patient tested positive for Lyme on two-tiered serum testing and was diagnosed with LNB. All three cases were associated with a delay to health care presentation (mean 20 days) and a delay to diagnosis and treatment (mean 54 days) due to under-recognition and ongoing evaluation. With the geographic expansion of Lyme disease, increasing awareness of LNB manifestations and acquiring detailed travel histories in low-incidence areas is crucial to prompt delivery of care. Clinicians should be aware of two-tiered serum diagnostic requirements and use adjunctive studies such as lumbar puncture and MRI to eliminate other diagnoses. Treatment with an appropriate course of antibiotics leads to robust improvement in neurological symptoms.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series

Palmer,

Sokola,

Uysal

et al. 2024

The Neurohospitalist

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“…Data used from the DASGIB database were registered by the local DASGIB representative or by specially trained research assistants during hospitalization [ 7 ]. All data were registered in a standardized web-based case report form using Research Electronic Data Capture (REDCap, Tennessee, TN, USA) [ 8 ]. Additional information was collected retrospectively by the principal investigator reviewing electronic medical records for all patients.…”

Section: Methodsmentioning

confidence: 99%

Cerebral abscesses with odontogenic origin: a population-based cohort study

et al. 2023

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Objectives Recent studies have indicated that cerebral abscess (CA) patients with odontogenic origin are on the rise. However, CA patients are often poorly characterized and with an unknown etiologic background. The purpose of this study is to identify and characterize CA patients that may have an odontogenic origin based on microbiologic, radiographic, and/or clinical findings. Materials and methods This is a population-based cohort study analyzing retrospective and prospective data from CA patients. Radiographic examinations of panoramic radiographs (PRs) or computed tomography (CT) scans were conducted. CA patients characterized with odontogenic origin required the fulfilment of the following criteria on admission: (1) Oral pathologic conditions were the only bacterial infections present, (2) oral microorganisms were isolated in the purulent exudate from the brain, and (3) radiographically and/or clinical recordings of oral pathologic conditions. Results A total of 44 patients could be included in this study of which 25 (57%) were characterized as having CA with a likely odontogenic origin. Type two diabetes (T2D) (p = 0.014) and microorganisms of the Streptococcus anginosus group (SAG) (p < 0.01) were overrepresented in patients with CAs of odontogenic origin. Conclusions Odontogenic infections may cause CAs to a greater extent than previously assumed. T2D was overrepresented among patients with odontogenic CA. When microorganisms of the SAG were isolated from the brain pus, CA patients had a predisposing odontogenic or sinus infection. Clinical relevance The identification of patients with a likely odontogenic CA will contribute to understanding the etiology of the infectious disease and highlighting the importance of preserving oral health.

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“…One study found that cranial imaging was often performed in elderly comorbid patients to rule out other diagnoses, whereas the second study observed that a substantial diagnostic delay and prolonged antibiotic treatment beyond 14 days was frequent in these patients. 60,61 Another study analyzed risk factors and prognosis of seizures in bacterial meningitis using a retrospective derivation cohort and subsequently validating the findings in the DASGIB cohort. 62 Risk factors for seizures consisted of pneumococcal etiology, immuno-compromise, and abnormal cranial imaging (mainly stroke), and seizures at any time during illness predicted both in-hospital mortality and unfavorable outcome at discharge.…”

Section: Research From the Databasementioning

confidence: 99%

Existing Data Sources for Clinical Epidemiology: The Danish Study Group of Infections of the Brain Database (DASGIB)

Bodilsen¹,

Larsen²,

Brandt³

et al. 2021

CLEP

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Central nervous system (CNS) infections are rare diseases that are associated with considerable morbidity and mortality. Increased knowledge based on contemporary data is a prerequisite for improved management and prevention of these serious conditions. Yet, population-based databases of patients hospitalized with CNS infections remain scarce. The Danish Study Group of Infections of the Brain (DASGIB) has prospectively registered information on all adults ≥18 years of age admitted with CNS infections at departments of infectious diseases in Denmark since 2015. The main variables collected are baseline demographics, blood and cerebrospinal fluid tests, imaging results, and outcome using the Glasgow Outcome Scale score. To investigate important aspects for each type of CNS infections, additional variables are included specifically for bacterial meningitis, viral meningitis, encephalitis, brain abscess, neurosyphilis, and Lyme neuroborreliosis. From 2015 to 2020, a total of 3579 cases of CNS infections have been recorded in the DASGIB database. Using the unique civil registration number assigned to all Danish residents, the database can be unambiguously linked with nationwide healthcare registries at the individual level. This enables researchers to conduct detailed population-based and longitudinal observational studies of risk and prognosis of CNS infections and to compare them with matched population cohorts. The database is well-suited for epidemiological research and the DASGIB network forms a solid infrastructure for future national and international collaborations.

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CT and MR neuroimaging findings in patients with Lyme neuroborreliosis: A national prospective cohort study

Cited by 9 publications

References 31 publications

Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series

Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series

Cerebral abscesses with odontogenic origin: a population-based cohort study

Existing Data Sources for Clinical Epidemiology: The Danish Study Group of Infections of the Brain Database (DASGIB)

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