Case review: 80-year-old with Lyme encephalopathy instead of dementia

lyme-encephalopathy

“An 80-year-old patient was admitted to the hospital after a fall, and subsequently developed an acute confused state requiring transfer to a neuropsychiatric unit,” writes Karrasch and colleagues in the journal Ticks and Tick-borne Diseases. [1]

 

“While mostly vigilant and awake, he intermittently lacked full orientation, had reduced attention, concentration, short-term memory function, increased motor activity, mild formal thought disorder (incl. some tangential thinking), but no frank psychotic symptoms,” the authors explain.

The man was diagnosed with delirium, potentially related to dementia. An abnormal F18-FDG-PET scan was interpreted as consistent with early Alzheimer’s disease. And memantine was prescribed.

However, the patient remained confused, despite receiving the antipsychotic medication risperidon and pipamperone for sleep disturbances. “The patient lacked orientation, had recurrent pervasive disturbances of sleep-wake-cycles, was intermittently restless, and also incontinent,” states Karrasch.

The patient’s spinal tap revealed an increased protein, lymphocytic pleocytosis of 260 leucocytes/μl, intrathecal IgM-synthesis, and elevated lactate. “The lymphocytic pleocytosis with signs of activation together with the dominance of intrathecal IgM-synthesis raised the differential diagnosis of neuroborreliosis,” writes Karrasch.

He also had an elevation of the chemokine CXCL13. And while this is not yet validated as a routine diagnostic tool, CSF [cerebrospinal fluid] CXCL13 may be another option to increase sensitivity and accuracy in diagnosing Neuroborreliosis, next to CSF lymphocytic pleocytosis, explains Karrasch.

The patient was given a 21-day course of ceftriaxone. As a result, his confusion and delirious symptoms resolved.

The man was “dismissed from the hospital in a clearly improved clinical status,” writes Karrasch, “despite an additional complication of aspiration pneumonia.”

The authors point out their case report demonstrates the possibility that confusion or acute encephalopathy can be a presenting feature of neuroborreliosis and that CXCL13 may be useful as a biomarker in central nervous system manifestations of Lyme borreliosis.

It is fortunate the doctors were able to recognize neuroborreliosis and successfully treat the 80-year-old man, or he might have been misdiagnosed with dementia.

References:
  1. Matthias Karrasch, Volker Fingerle, Katharina Boden, Andreas Darr, Michael Baier, Eberhard Straube, Igor Nenadic, Neuroborreliosis and acute encephalopathy: The use of CXCL13 as a biomarker in CNS manifestations of Lyme borreliosis, Ticks and Tick-borne Diseases, Volume 9, Issue 2, 2018, Pages 415-417, ISSN 1877-959X, https://doi.org/10.1016/j.ttbdis.2017.12.008.


3 Replies to "Case review: 80-year-old with Lyme encephalopathy instead of dementia"

  • Sarah Jane Slack
    02/12/2022 (3:36 pm)
    Reply

    Can anyone help or point me in the right direction?

    I’ve been suffering with additional neurological issues in the last few years (on top of the delightful array of Lyme symptoms I’ve had for 23 years in total). I’m tyring to work out whether this particular set of new symptoms tie in with my starting the anti biotics 2.5 years ago but can’t recall.

    In essence my short term memory is dire. I can never remember anything earlier in the day or in previous days. It all just feels like a blank brick wall of nothing. I sometimes spend an hour just thinking did I bath before bed last night and there’s no info there at all. I have additional confusion around word finding and get confused very easily. My long term memory by contrast is still great. I’m seeing  a Neurologist on Thursday on the NHS to look into the memory loss and inc to cognitive symptoms and weird dementia like symptoms (even though I’m sure they are more likely Lyme related).

    Do I mention I have Lyme and is there any specific scan I should ask for? Or anything 8 can take in terms of info as I’m assuming that as the NHS don’t recognise Lyme this won’t be a consideration. I’ve seen numerous links between dementia like symptoms and misdiagnosis and don’t want to get the wrong diagnosis treatment.

  • Catherine mihm
    05/29/2018 (8:25 pm)
    Reply

    I have suspected this for years. .also M.S….bites from ticks, mites, spiders and scratches from infected animals. 💚💋

  • Bonnie Huntsinger
    01/05/2018 (5:31 am)
    Reply

    I am age 61 and I have battled neuroborreliosis. My mother is age 87 and has been diagnosed with severe anxiety and dementia. It angers me that nobody even thinks to search for… nor test and treat neuroborreliosis.


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