What are the main spirochaete infections of the CNS?
Lymes Disease (Borrelia Burgorferi)
Syphilis (Trepomena Pallidum)
Leptospirosis (Leptospira Interrogans)
How is Lyme’s Disease Spread?
Vector Borne, ticks in wooded areas
How does Lyme’s Disese present?
Its a multi system disease that comes in 3 stages:
Describe Stage 1 of Lyme’s Disease?
Early localised infection (first month) with erythema migrans rash at site of bite possibly with flu symptoms
Describe stage 2 of Lyme’s Disease?
Early Disseminated Infection over weeks->months
Spreads through lymph or blood to 1 or more systems (Musculoskeletal & Neurological are most common)
What are the neurological manifestations of lymes disease?
- Mononeuropathy
- Myelitis
- Painful Radiculoneuropathy
- Cranial Neuropathy
- Meningo-encephalitis
PNS more than CNS
And in stage 3 can get subacute encephalopathy and encephalomyelitis
How do we investigate/treat Lymes DIsease?
- Serology
- CSF Lymphocytosis & PCR
- Brain/Spine MRI if CNS manifestations
- Nerve Conduction study/EMG If PNS manifestations
Prolonged Treatment with IV Ceftriaxone or Oral Doxycycline
How does syphilis affect the brain?
Syphilis comes in 3 stages
Primary -> Secondary -> Latent -> Tertiary
So Tertiary syphilis can present as neurosyphilis years or decades after infection
How do we investigate/treat Neurosyphilis?
- Treponema Specific and non-specific antibody tests
- LP for raised Lymphocytes, intrathecal (in spinal cord) antibody production and PCR
Treat with High dose Penicillin
How long does Lymes Disease take to reach stage 3?
Months to years after exposure
Notably it occurs after a period of latency between stage 2&3
