Oksi J, Kalimo H, Marttila R J, Marjamäki M, Sonninen P, Nikoskelainen J, Viljanen M K
Department of Internal Medicine, Turku University Central Hospital, Finland.
Brain. 1996 Dec;119 ( Pt 6):2143-54. doi: 10.1093/brain/119.6.2143.
Despite a rapid increase in the number of patients with Lyme neuroborreliosis (LNB), its neuropathological aspects are poorly understood. The objective of this study was evaluation of neuropathological, microbiological, and magnetic resonance imaging (MRI) findings in three patients with the Borrelia burgdorferi infection and neurological disease from whom brain tissue specimens were available. Perivascular or vasculitic lymphocytic inflammation was detected in all specimens. Large areas of demyelination in periventricular white matter were detected histologically and by MRI in one patient. The disease had a fatal outcome in this patient. Brain MRI suggested malignancies in two patients before histopathological studies were carried out. One of these two patients was a child with sudden hemiparesis. Another was a 40-year-old man presenting with epileptic seizures and MRI-detected multifocal lesions, which disappeared after repeated courses of antibiotics. We conclude that cerebral lymphocytic vasculitis and multifocal encephalitis may be associated with B. burgdorferi infection. The presence of B. burgdorferi DNA in tissue samples from areas with inflammatory changes indicates that direct invasion of B. burgdorferi may be the pathogenetic mechanism for focal encephalitis in LNB.
尽管莱姆病神经伯氏疏螺旋体病（LNB）患者数量迅速增加，但其神经病理学方面仍知之甚少。本研究的目的是评估三名患有伯氏疏螺旋体感染和神经系统疾病且可获取脑组织标本的患者的神经病理学、微生物学和磁共振成像（MRI）结果。在所有标本中均检测到血管周围或血管炎性淋巴细胞炎症。在一名患者中，通过组织学和MRI在脑室周围白质中检测到大面积脱髓鞘。该患者病情最终致命。在进行组织病理学研究之前，两名患者的脑部MRI提示为恶性肿瘤。这两名患者中的一名是患有突发偏瘫的儿童。另一名是40岁男性，表现为癫痫发作且MRI检测到多灶性病变，在反复使用抗生素治疗后病变消失。我们得出结论，脑淋巴细胞性血管炎和多灶性脑炎可能与伯氏疏螺旋体感染有关。在有炎症变化区域的组织样本中存在伯氏疏螺旋体DNA表明，伯氏疏螺旋体的直接侵袭可能是LNB中局灶性脑炎的发病机制。
