Lyme disease other imaging findings: Difference between revisions
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==Overview== | ==Overview== | ||
[[Single photon emission computed tomography]] is one of the major other imaging modalities of Lyme disease. In Lyme patients, cerebral [[hypoperfusion]] of frontal [[Basal ganglia|subcortical]] and [[Cerebral cortex|cortical]] structures has been found. | [[Single photon emission computed tomography]] is one of the major other imaging modalities of [[Lyme disease]]. In [[Lyme disease|Lyme]] patients, cerebral [[hypoperfusion]] of frontal [[Basal ganglia|subcortical]] and [[Cerebral cortex|cortical]] structures has been found. | ||
==Other Imaging Findings== | ==Other Imaging Findings== | ||
===Single Photon Emission Computed Tomography (SPECT)=== | ===Single Photon Emission Computed Tomography (SPECT)=== | ||
* [[Single photon emission computed tomography]] (SPECT) imaging has been used to look for [[cerebral]] [[perfusion|hypoperfusion]] which indicates Lyme [[encephalitis]] in the patient.<ref>{{cite journal |author=Sumiya H, Kobayashi K, Mizukoshi C, ''et al'' |title=Brain perfusion SPECT in Lyme neuroborreliosis |journal=J. Nucl. Med. |volume=38 |issue=7 |pages=1120-2 |year=1997 |pmid=9225802 }}</ref> | * [[Single photon emission computed tomography]] ([[SPECT]]) imaging has been used to look for [[cerebral]] [[perfusion|hypoperfusion]] which indicates [[Lyme disease|Lyme]] [[encephalitis]] in the patient.<ref>{{cite journal |author=Sumiya H, Kobayashi K, Mizukoshi C, ''et al'' |title=Brain perfusion SPECT in Lyme neuroborreliosis |journal=J. Nucl. Med. |volume=38 |issue=7 |pages=1120-2 |year=1997 |pmid=9225802 }}</ref> | ||
* In Lyme patients, cerebral [[hypoperfusion]] of frontal [[Basal ganglia|subcortical]] and [[Cerebral cortex|cortical]] structures has been found.<ref>{{cite journal |author=Logigian EL, Johnson KA, Kijewski MF, ''et al'' |title=Reversible cerebral hypoperfusion in Lyme encephalopathy |journal=Neurology |volume=49 |issue=6 |pages=1661-70 |year=1997 |pmid=9409364 }}</ref> | * In [[Lyme]] patients, cerebral [[hypoperfusion]] of frontal [[Basal ganglia|subcortical]] and [[Cerebral cortex|cortical]] structures has been found.<ref>{{cite journal |author=Logigian EL, Johnson KA, Kijewski MF, ''et al'' |title=Reversible cerebral hypoperfusion in Lyme encephalopathy |journal=Neurology |volume=49 |issue=6 |pages=1661-70 |year=1997 |pmid=9409364 }}</ref> | ||
* In about 70% of late stage Lyme disease patients with cognitive symptoms, brain SPECT scans typically show a pattern of global [[hypoperfusion]] in a heterogeneous distribution through the [[white matter]].<ref>{{cite journal |author=Fallon BA, Das S, Plutchok JJ, Tager F, Liegner K, Van Heertum R |title=Functional brain imaging and neuropsychological testing in Lyme disease |journal=Clin. Infect. Dis. |volume=25 Suppl 1 |issue= |pages=S57-63 |year=1997 |pmid=9233666 }}</ref> | * In about 70% of [[Lyme disease history and symptoms#Symptoms|late stage Lyme disease]] patients with [[Cognition|cognitive]] symptoms, brain [[SPECT]] scans typically show a pattern of global [[hypoperfusion]] in a heterogeneous distribution through the [[white matter]].<ref>{{cite journal |author=Fallon BA, Das S, Plutchok JJ, Tager F, Liegner K, Van Heertum R |title=Functional brain imaging and neuropsychological testing in Lyme disease |journal=Clin. Infect. Dis. |volume=25 Suppl 1 |issue= |pages=S57-63 |year=1997 |pmid=9233666 }}</ref> | ||
* This is a non specific pattern for Lyme disease, as similar pattern can be observed in other [[central nervous system]] (CNS) syndromes such as [[HIV]] [[encephalopathy]], viral [[encephalopathy]], chronic [[cocaine]] use, and [[vasculitides]]. | * This is a non specific pattern for [[Lyme disease]], as similar pattern can be observed in other [[central nervous system]] (CNS) syndromes such as [[HIV]] [[encephalopathy]], viral [[encephalopathy]], chronic [[cocaine]] use, and [[vasculitides]]. | ||
* Careful history taking of the patient and serologic testing can easily rule out most of these syndromes. | * Careful history taking of the patient and [[Serological testing|serologic testing]] can easily rule out most of these [[syndromes]]. | ||
* Global cerebral [[hypoperfusion]] deficits on SPECT in the presence of characteristic neuropsychiatric features of Lyme disease should raise suspicion of Lyme [[encephalopathy]] among patients who inhabit or have traveled to endemic areas, regardless of patient recall of a tick bite. | * Global cerebral [[hypoperfusion]] deficits on [[SPECT]] in the presence of characteristic [[neuropsychiatric]] features of [[Lyme disease]] should raise suspicion of [[Lyme]] [[encephalopathy]] among patients who inhabit or have traveled to [[endemic]] areas, regardless of patient recall of a [[tick]] bite. | ||
* Late stage Lyme disease can occur many years after initial infection. | * [[Lyme disease history and symptoms#Symptom|Late stage Lyme disease]] can occur many years after initial [[infection]]. | ||
* The average time from symptom onset to diagnosis in these patients is about 4 years. | * The average time from symptom onset to diagnosis in these patients is about 4 years. | ||
* Seronegative disease can occur, and because CSF testing is often normal, Lyme [[encephalopathy]] often becomes a diagnosis of exclusion. | * [[Seronegative]] disease can occur, and because [[CSF]] testing is often normal, Lyme [[encephalopathy]] often becomes a diagnosis of exclusion. | ||
* Aberrant SPECT patterns are caused by [[cerebral vasculitis]]. [[Brain biopsy]] is not commonly performed for these cases, as opposed to other types of [[cerebral vasculitis]]. | * Aberrant [[SPECT]] patterns are caused by [[cerebral vasculitis]], a [[vasculitides]]. [[Brain biopsy]] is not commonly performed for these cases, as opposed to other types of [[cerebral vasculitis]]. | ||
==References== | ==References== | ||
Revision as of 16:28, 8 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]
Overview
Single photon emission computed tomography is one of the major other imaging modalities of Lyme disease. In Lyme patients, cerebral hypoperfusion of frontal subcortical and cortical structures has been found.
Other Imaging Findings
Single Photon Emission Computed Tomography (SPECT)
- Single photon emission computed tomography (SPECT) imaging has been used to look for cerebral hypoperfusion which indicates Lyme encephalitis in the patient.[1]
- In Lyme patients, cerebral hypoperfusion of frontal subcortical and cortical structures has been found.[2]
- In about 70% of late stage Lyme disease patients with cognitive symptoms, brain SPECT scans typically show a pattern of global hypoperfusion in a heterogeneous distribution through the white matter.[3]
- This is a non specific pattern for Lyme disease, as similar pattern can be observed in other central nervous system (CNS) syndromes such as HIV encephalopathy, viral encephalopathy, chronic cocaine use, and vasculitides.
- Careful history taking of the patient and serologic testing can easily rule out most of these syndromes.
- Global cerebral hypoperfusion deficits on SPECT in the presence of characteristic neuropsychiatric features of Lyme disease should raise suspicion of Lyme encephalopathy among patients who inhabit or have traveled to endemic areas, regardless of patient recall of a tick bite.
- Late stage Lyme disease can occur many years after initial infection.
- The average time from symptom onset to diagnosis in these patients is about 4 years.
- Seronegative disease can occur, and because CSF testing is often normal, Lyme encephalopathy often becomes a diagnosis of exclusion.
- Aberrant SPECT patterns are caused by cerebral vasculitis, a vasculitides. Brain biopsy is not commonly performed for these cases, as opposed to other types of cerebral vasculitis.
References
- ↑ Sumiya H, Kobayashi K, Mizukoshi C; et al. (1997). "Brain perfusion SPECT in Lyme neuroborreliosis". J. Nucl. Med. 38 (7): 1120–2. PMID 9225802.
- ↑ Logigian EL, Johnson KA, Kijewski MF; et al. (1997). "Reversible cerebral hypoperfusion in Lyme encephalopathy". Neurology. 49 (6): 1661–70. PMID 9409364.
- ↑ Fallon BA, Das S, Plutchok JJ, Tager F, Liegner K, Van Heertum R (1997). "Functional brain imaging and neuropsychological testing in Lyme disease". Clin. Infect. Dis. 25 Suppl 1: S57–63. PMID 9233666.