Spirochete infections Boreliosis (Lyme disease) Borrelia burgdorferi Syphylis (Lues) Treponema pallidum

Borrelia burgdorferi

Summary of reported cases of Lyme disease in the United States. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30: ©2009 by American Society of Neuroradiology

Lyme disease

Skin lesion After tick bite

Erythema migrans rash with the typical target appearance that is virtually diagnostic of Lyme disease. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30: ©2009 by American Society of Neuroradiology

Lyme disease

Clinical feature 10-15% patients with untreated borreliosis – neuroborelliosis Primary location – ganglia od posterior roots, nerv roots, leptomeninges (macacus rhesus) Europe –– B. garinii

Clinical feature Periferal NS Sensory symptoms Painful radiculitis Painful lymphocytic meningoradiculitis – with/without paresis (Garin-Bujadoux- Bannwart syndróm) Facial palsy Pain – sharp, during night, weeks – months

Clinical feature Central NS Subsequent to the tick bite inoculation – B. reach reach the CNS Hematogenously or retrogradely via periferal nerves Encefalitis Cranial neuritis Motor or sensitive radikuloneuroitis Encefalomyelitis - rare

Clinical feature late presentation Dementia – often in patients with artritis Desorientation, confusion, memory problems, cognitive dysfunction Chronic radikuloneuropathy – parestesia of acral parts, pain, EMG – axonal lesion

Diagnosis EMG – axonal lesion CSF: pleocytosis – Ly,  proteins intratecal antibodies IgM, IgG against BB PCR

Facial neuritis. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30: ©2009 by American Society of Neuroradiology

Evolving cranial neuritis. Enhancement n. III, V l.dx., VII l. sin. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30: ©2009 by American Society of Neuroradiology

A 50-year-old woman with a history of tick bite and erythema migrans rash treated with doxycycline, who had recurrent erythema migrans rash with headache, fever, nausea, and nuchal rigidity. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30: ©2009 by American Society of Neuroradiology

A 74-year-old man with 2-year cognitive decline and memory loss. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30: ©2009 by American Society of Neuroradiology

A 56-year-old woman with neck, bilateral shoulder, and bilateral arm pain. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30: ©2009 by American Society of Neuroradiology

A 17-year-old boy with right papilledema and orbital pain and rule out pseudotumor. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30: ©2009 by American Society of Neuroradiology

Boreliosis Th: Doxycycline (2x100 mg/D, 2T) CSF negat. i.v. ceftriaxone – likvor pozit.

Syphilis (Lues) 1/3 nontreated patients – neurovascular complications of syphylis

Neurosyphilis Patogenesis Perivascular infiltration of the meninges, focal meningeal inflammation – formation of hypertrophic meninges, or gumma, Inflammatory cells invide blood vessel wal – arteritis (luminal occlusion) Parenchymal involvement – gliosis in late stages Ly infiltration of preganglionic portion of dorsal roots and posterior columns atrophy of posterior columns

Neurosyfilis – meningitis CSF Ly, ↓ Glu,  proteins Pozit. VDRL test

Neurosyfilis – meningovascular Endarteritis – small and medium vessels (MCA) – can be stroke etiology in young people !!! Focal signs AG: nerrowing of arteries MRI: multiple infarcts Spinal artery – transversal myelitis

Demencia paralytica Progressive paralysis Decreased cognitive functions, memory problems, pupils abnormality

Tabes dorsalis Paresthesias in root distribution Decreased proprioception Spinal ataxia Argyll-Roberts pupils

Acquired immunodeficiency syndrom (AIDS) Human immunodeficiency virus (HIV) I. stage Acute infection weeks after infection by HIV Symptoms like flu, or mononukleosis Acute retroviral syndrom

Stage II Period without symptoms – 2-10 years or more Decreased imunity in this period

Stage III, IV III – generalized lymphadenopathy, enlargement of LN IV- stage of AIDS Weakened immune system fails Fewer, lost of weight, weakness, fatigue, muscle atrophy

Acquired immunodeficiency syndrom (AIDS) IV stage - symptoms of lesion of PNS and CNS Aseptic meningitis Cognitive decline Myelopathy Neuropathy (inflammatory demyelinating polyneuropathy, mononeuropathy, plexopathy) Myopathy – myositis

AIDS dementia complex (ADC) T2- MRI: Enlargement of ventricles Hyperintensity in subcortical white matter of frontal lobes Brain atrophy

HIV Opportunistic Infections People with advanced HIV infection are vulnerable to infections and malignancies that are called 'opportunistic infections' because they take advantage of the opportunity offered by a weakened immune system. Bacterial diseases such as tuberculosis, Mycobacterium avium complex, bacterial pneumonia and septicaemia (blood poisoning) Protozoal diseases such as toxoplasmosis, microsporidiosis, cryptosporidiosis, isopsoriasis and leishmaniasis

HIV Opportunistic Infections Fungal diseases such as Pneumocystis pneumonia, candidiasis, cryptococcosis and penicilliosis Viral diseases such as those caused by cytomegalovirus, herpes simplex and herpes zoster virus HIV-associated malignancies such as Kaposi's sarcoma, lymphoma and squamous cell carcinoma.