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The patient was a 35 year old right-
handed construction worker who was well until July 1979. At that
time, he developed erythema migrans in association with flu-like
symptoms. Four days later right facial palsy and fatigue developed,
but resolved within one month. Five months later, in December, he
developed oligoarticular arthritis affecting the knees which resolved
spontaneously by 1983. In 1985, 6 years after onset of infection, the
patient's wife noted that he had become very forgetful and was
tending to fall asleep in the afternoons while on the job. There were
no symptoms of another disease process, new medicines, or drug
abuse to explain his symptoms. On examination at the bedside he
appeared normal. However, on neuropsychological tests he had a
markedly abnormal verbal memory despite a normal IQ. His spinal
fluid showed no pleocytosis but had an elevated protein of 97 mg %.
His serum Lyme titer was elevated, but more importantly, he had
selective concentration of antibody in spinal fluid with a CSF/serum
ratio of 1.3. MR of the brain and a polysomnogram were
normal. He was treated with a one month course of IV ceftriaxone
and gradually improved over 3-6 months with decrease in his spinal
fluid protein from 97 to 70 to 52. Neuropsychologic tests improved
but were still slightly abnormal at 6 months after therapy. Perfusion SPECT shows multifocal abnormalities of perfusion largely affecting the frontal lobes and hemispheric white matter. MR is normal. After antibiotic therapy, the perfusion abnormalities improved. To see this best, use the "time" button. Dr. Eric Logigian's brief review of this disorder is here. | |||
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