Henriëtte schreef:Dit soort klachten overlappen ook wat Lymeklachten en dat is ook weer verwarrend.
Henriëtte schreef: bedankt dat je zoveel moeite van het opzoeken hebt gedaan
Cerebral 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.
In addition to the pathophysiology, unusual aspects of our case are the cranial MRI scans that showed ischemic lesions in the vascular territory of the middle cerebral artery. Serology and molecular techniques confirmed infection with B. garinii.
Therefore we believe that the vascular pathology in this patient is a manifestation of a “cerebrovascular course” of neuroborrelio-
sis (Wilke et al 2000). Vasculitis has for a long time been postulated as the mechanism of nervous system injury in Borrelia
infection, and case reports of several patients have been published (Back et al 2013).
Based on a small study Dr. Fallon published in 1999 on patients with persistent memory problems that suggested cognition improves with a repeated course of IV antibiotic therapy and on his functional imaging research that suggested Lyme disease causes a vasculitis-like pattern in the brain, Dr. Fallon received a $4.7 million grant from the NIH to test the hypothesis that repeated antibiotic therapy can help patients with persistent problems.
Vascular Changes Seen on Brain MRIs of Lyme Patients
The findings on a Lyme disease MRI vary amongst individuals but may show evidence of cerebral atrophy, including abnormal signalling within the white matter of the brain and in the brain stem. This loss of signalling function may be due to demyelination, or alterations in vascularity in the brain. Some patients may have calcification of areas of the brain which compromise cognitive function
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.
Based on vascular studies, which were available in most cases, we classified LNB-associated vasculitis into three main groups: (1) large-sized blood vessels vasculitis; (2) small-sized blood vessels vasculitis, or (3) variable-sized blood vessels vasculitis (both large- and small-sized vessels). Large vessels included internal carotid arteries (ICA), the vertebral arteries (VA), the anterior cerebral artery (ACA) and their main branches, the middle cerebral arteries (MCA) and their main branches, the posterior cerebral arteries (PCA), the basilar artery (BA) and their main branches, the transverse sinuses, the sigmoid sinuses, and the superior sagittal sinus. Small vessels included the small penetrating arteries (e.g., the lenticulostriate arteries) that supplied the deep structures of the brain.
Doctors are taught in formal training how much the inflammation in the arteries contributes to strokes, heart attacks, and other cardiovascular diseases, but much less is known about how inflammation in the veins affects health. This is an area where much research still needs to be done, but it is important for the reader to be aware that Lyme disease may be playing a large, previously unrecognized role in vascular diseases, especially venous diseases.
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