Lyme disease other imaging findings: Difference between revisions

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{{Lyme disease}}
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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 reported.
[[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]] indicative of 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]].<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 reported.<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 chronic 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 pattern is not specific for Lyme disease, as it can also be seen in other [[central nervous system]] (CNS) syndromes such as [[HIV]] [[encephalopathy]], viral [[encephalopathy]], chronic [[cocaine]] use, and [[vasculitides]].   
* This is a nonspecific pattern for [[Lyme disease]], as a similar pattern can be observed in other [[central nervous system]] (CNS) syndromes such as [[HIV]] [[encephalopathy]], viral [[encephalopathy]], chronic [[cocaine]] use, and [[vasculitides]].   
* Most of these syndromes can be easily ruled out through standard serologic testing and careful history taking of the patient.  
* Careful history taking of the patient and [[Serological testing|serologic testing]] can easily rule out most of these [[syndromes]].  


* The presence of global cerebral [[hypoperfusion]] deficits on SPECT in the presence of characteristic neuropsychiatric features should dramatically 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 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 due to efforts by the [[CDC]] and infectious disease communities to cover up the illness.
* The average time from symptom onset to diagnosis in these patients is about 4 years.
* Seronegative disease can occur, and because CFS testing is often normal, Lyme [[encephalopathy]] often becomes a diagnosis of exclusion: once all other possibilities are ruled out, LE becomes ruled in.  
* [[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 [[Vasculitis|vasculitide]]. [[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==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 22:35, 29 July 2020

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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)

References

  1. Sumiya H, Kobayashi K, Mizukoshi C; et al. (1997). "Brain perfusion SPECT in Lyme neuroborreliosis". J. Nucl. Med. 38 (7): 1120–2. PMID 9225802.
  2. Logigian EL, Johnson KA, Kijewski MF; et al. (1997). "Reversible cerebral hypoperfusion in Lyme encephalopathy". Neurology. 49 (6): 1661–70. PMID 9409364.
  3. 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.


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