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From the Departmenb of Neurology (Dn. Halperin and Krupp), Pathology (Dr. Golightly), and Internal Medicine (Dr. Volkman), State University of New York, Stony Brook, NY.
Borrelia burgdorferi infection (Lyme disease) is frequently accompanied by CNS dysfunction. Particularly common is a mild confusional state, the mechanism of which is unknown. Since CNS infection with B burgdorferi is usually accompanied by intrathecal synthesis of specific antibody, we studied CSF in 73 patients referred for presumed CNS Lyme, manifested primarily as this confusional state. Of 30 seropositive patients evaluated, only 5 had intrathecal antibody production. Seven seronegative patients had positive cell-mediated immune responses to B burgdorferi in the peripheral blood none had antibody production in the CSF. Of the remaining 36 patients referred with this diagnosis despite negative serologic studies, none had compelling evidence of CNS infection by this criterion. We conclude that CNS infection with B burgdorferi does occur in a small proportion of seropositive patients with this confusional state but is extremely uncommon among seronegative individuals with this clinical presentation.
Address correspondence and reprint requests to Dr. John J. Halperin, Department of Neurology, HSC T12-020, SUNY, Stony Brook, NY 11794.
Supported in part by a grant for Lyme Disease Research from the State of New Yorbt.
Received March 23, 1990. Accepted for publication in final form May 9, 1990.
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