NEUROLOGY 1997;49:1661-1670
© 1997 American Academy of Neurology
Reversible cerebral hypoperfusion in Lyme encephalopathy
E. L. Logigian, MD,
K. A. Johnson, MD,
M. F. Kijewski, ScD,
R. F. Kaplan, PhD,
J. A. Becker, BS,
K. J. Jones, PhD,
B. M. Garada, MD,
B. L. Holman, MD and
A. C. Steere, MD
From the Departments of Neurology (Drs. Logigian and Johnson) and Radiology (Drs. Johnson, Kijewski, Becker, Garada, and Holman), Brigham and Women's Hospital, Harvard Medical School, Cambridge; Department of Neurology (Dr. Kaplan) and Division of Rheumatology (Dr. Steere), New England Medical Center, Tufts University School of Medicine, Medford; Department of Physics (J.A. Becker), Massachusetts Institute of Technology, Cambridge; and the Heller School (Dr. Jones), Brandeis University, Waltham, MA.
Address correspondence and reprint requests to Dr. Keith A. Johnson, Department of Neurology, Harvard Medical School, 75 Francis St., Boston, MA 02115.
Lyme encephalopathy (LE) presents with subtle neuropsychiatric symptoms months to years after onset of infection with Borrelia burgdorferi. Brain magnetic resonance images are usually normal. We asked whether quantitative single photon emission computed tomography (SPECT) is a useful method to diagnose LE, to measure the response to antibiotic therapy, and to determine its neuroanatomic basis. In 13 patients with objective evidence of LE, SPECT demonstrated reduced cerebral perfusion (mean perfusion defect index [PDI] = 255), particularly in frontal subcortical and cortical regions. Six months after treatment with 1 month of intravenous ceftriaxone, perfusion significantly improved in all 13 patients (mean PDI = 188). In nine patients with neuropsychiatric symptoms following Lyme disease, but without objective abnormalities (e.g., possible LE), perfusion was similar to that of the treated LE group (mean PDI = 198); six possible LE patients (67%) had already received ceftriaxone prior to our evaluation. Perfusion was significantly lower in patients with LE and possible LE than in 26 normal subjects (mean PDI = 136), but 4 normal subjects (15%) had low perfusion in the LE range. We conclude that LE patients have hypoperfusion of frontal subcortical and cortical structures that is partially reversed after ceftriaxone therapy. However, SPECT cannot be used alone to diagnose LE or determine the presence of active CNS infection.
Supported in part by NIH grants NS-31902 (M.F.K., K.A.J.) and AR-20358(A.C.S.).
Received December 6, 1996. Accepted in final form June 19, 1997.
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