Introduction
Material and methods
Case reports
(Patient number), age at diagnosis (years), sex, (reference) | History of tick bite, EM or BS | Duration of symptoms prior to TX | Weight-loss | Nausea, malaise, vomiting | Head-ache | Voiding dysfunction | Tremor | Falls, gait disturbance | Other focal neurological signs | Neuroimaging | STT response |
---|---|---|---|---|---|---|---|---|---|---|---|
(1) 60, male [53] | EM? 12 ma BS? 11 ma | 6 m | Nm | Nm | Nm | + | Nm | + | No | cCT: normal | Nm |
(2) 74, female [54] | No | 8 m | Nm | Nm | Nm | + | Nm | + | No | MRI: ventricular dilatation, patch-like subependymal signal abnormalities, compatible with NPH | Yes/no |
(3) 33, male [55] | No | 8 m | Nm | Nm | Nm | Nm | Nm | + | Pyramidal signs | MRI: small hyperintense lesions close to cornu anterior and capsula externa | Nm |
(4) 76, male [56] | Nm | 6 m | + | Nm | Nm | + | Nm | + | No | MRI: ventricular dilatation suggesting NPH | Nm |
(5) 83, female [57] | Repeated tick bites | 6 m | 5–7 kg | Nm | Nm | + | + | + | Diplopia | MRI: leukoaraiosis, ischemic lesion near left N lentiformis, enlarged ventricles suspicious for NPH | Yes/yes |
(6) 69, female [39] | Remote tick bites | 12 m | Nm | Nm | Nm | + | Nm | + | Babinski, leg weakness | MRI: symmetrical WML, meningeal GAD enhancement | Nm |
(7) 75, female [58] | No | 10 m | Nm | + | + | + | Nm | + | Rigor, brady-kinesia | MRI: mild periventricular white matter changes, widening of the lateral ventricles, Evans index 0.34 | CSF < 10 ml |
(8) 80, female [7] | No | 6 m | Nm | Nm | Nm | + | + | (+) | No | MRI: enlarged ventricles, periventricular lesions | Yes/yes |
(9) 71, female [8] | Tick bite EM ? 4 ma | 3 m | 15 kg | + | + | + | + | + | No | MRI: ventricles enlarged, bilateral mesiotemporal atrophy, widened insular cistern, cella media index 3.4. FDG-PET: normal | No |
(10) 77, female | No | 12 m | 20 kg | + | + | Nm | + | + | No | MRI: bilateral WML, striatal lacunar lesion. FDG-PET: frontotemporal hypo-metabolism | No |
(Patient number), reference TX, follow-up | Pre-/post-TX: cognitive impairment, MRI | MMSE | Pre-/post-TX: other neurocognitive tests | Pre-/post-TX: CSF |
---|---|---|---|---|
(1), [53] | Loss of memory and orientation in time, unable to cope with daily activities | Nm | Nm | Cc: 285/µl; tp: 3600 mg/l |
2 w benzylpenicillin IV | Mental condition improved, memory poor, needs daily help (1 year after TX) | Nm | Nm | Cc: 88/µl; tp: 700 mg/l AI: 20 |
(2), [54] | Reduced attention and memory, confused, completely dependent | 20/30 | Digit-symbol (WAIS): 3; CAT: phasic and tonic alertness at least 1 sd below controls | Cc: 89/µl; tp: 1910 mg/l; OCB+; AI: 12.6 |
18 m after 2 w c | Memory normal, independent; MRI: idem | 29/30 | Digit symbol: 11; CAT: >1 sd above controls | Cc: 2/µl; tp: 290 mg/l; AI: >12.5 |
(3), [55] | Progressing impairment of memory and concentration | Nm | Nm | Cc: 51/µl; tp: 260 mg/l; OCB+; AI+ |
9 m after start of 2 w c | Major regression of cognitive impairment | Nm | Nm | Cc: 6/µl; AI+ |
(4), [56] | Amnesia for recent events, disorientation | 15/30 | Mattis Scale 98/144 | Cc: 250/µl; tp: 3000 mg/dl (sic); AI: 19.7 |
4 w after start of 4? or 12? w c | No cognitive impairment after reassessment; MRI: unchanged after 1 m | “No impairment in neurocognitive tests” | “CSF normal” (12 w after start of TX) | |
(5), [57] | Impairment of memory and “wordfinding” | 18/30 | CERAD: impairment of vf and recall of world list | Cc: 69/µl; tp: 3542 mg/l; lactate: 4.8 mmol/l; AI: 31.1 |
7 m after 2 w c followed by 3 m a | No memory problems, no problems with daily activities | 27/30 | CERAD: vf, recall of world list improved | Nd |
(6), [39] | Rapidly progressing dementia, short-term memory severely impaired, disoriented | Nm | Nm | Cc: 44/µl; alb: 3570 mg/l; lactate: 6.1 mmol/l; OCB-; AI: 10.5 |
5 m after 3 w c | No signs of cognitive impairment; MRI: improvement after 5 y | Nm | Nm | Alb: 244 mg/l; AI: 581 |
(7), [58] | Not fully oriented, attention, concentration and short-term memory reduced | 20/30 | Nm | Cc: 30/µl; tp: 1540 mg/l; lactate: 2.9 mmol/l; OCB+; AI: 18.5 |
a) 3 w, b) 4 m and c) 15 m after 3 w c | a), b) and c): complete remission; MRI: unchanged after 15 m | a) 28/30 b) 30/30 c) 30/30 | Nm | Cc: a) 19 b) 3/µl; tp: a) 540 b) 390 mg/l lactate: a) 1.9 b) 1.6 mmol/l OCB (a and b)+; AI: a) 21.1: b) 49.9 |
(8), [7] | Reduced attention and memory, amnesia for recent events, spatiotemporal disorientation | 21/30 | Nm | Cc: 45/µl; tp: 523 mg/l; OCB+; AI: 13.6 |
2 m after start of 4 w c | Complete recovery; MRI: unchanged | 29/30 | Nm | Cc: 7/µl; tp: 370 mg/l; OCB+; AI: 10.9 |
(9), [8] | Spatiotemporal disoriented, reduced attention and memory, optic hallucinations | 17/30 | IDSR-5: −3.51, IDSR-7: −2.149 (z-score); CDT: 3/9 | Cc: 321/µl; tp: 2351 mg/l; OCB+; AI: 7.0 |
(a) 11 d, (b) 12 m after start of 2 w c | a) Improvement in all neuropsychological parameters; b) stable | a) 27/30 b) 29/30 | a) IDSR 5: +0.733, IDSR 7: −0.280 (z-score); a) CDT; 7/9 | Nd |
(10) case report | Attention-, memory-and executive deficits | 22/30 | CERAD, WMS-R, MT, CDT | Cc: 61/µl; tp: 3690 mg/l; OCB+; AI: 7.4 |
6 w (CSF), 6 m after 3 w c | Major improvement; MRI not improved | 28/30 | Cc: 17/µl; tp: 1792 mg/l; OCB+; AI: 14.1 |