posted
Went to appointment with family duck armed with blood test results showing low positive tests for Rock Mt Spotted fever, Bartenella and an MRI indicating abnormalities on brain were consistent with Lymes disease; Results
Me Blood tests DD indeterminent Me MRI results point to lyme DD that's also indeterminent Me Taking high dose antibiotics for 10 months, headaches, stiff neck, arthritis like feelings are gone. Also gone is acid reflux. No longer need to use Previcid DD Thats doesn't sound right. Acid reflux gets worse with antibiotics. Are you sure you are taking antibiotics? ME Took Mepron in Sept and my fatigue is gone DD that's just a placebo effect - This effect can last three months Me I don't sleep well at nights, up very early and have shocking nightmares at times DD that's called post traumatic stress....
DD I am making an appt with specialist duck. The one that saw you for 15 minutes and insists you have lupus of the brain. (DD shows me speciatist ducks letter saying there has been a lot of contrevery over his diagnosis but he is absolutely certain he is correct.
This is where I need help>>>>>
Have 20 adnormal spots on each side of brain as seen on MRI in March. These spots have not changed from MRI's taken in 2000 and 2002. I started taking antibiotics, Flagy, Biaxin, Ketek, Zithro since March. I understand that if these spots are lyme related that some will have disappeared with long term antibiotics. Does anyone know how fast this process happens and if it happens to all patients with these abnormalities. Anyone know of any URL's with studies on this?
Posts: 66 | From BC Canada | Registered: Jan 2005
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posted
All I have heard are anecdotal reports, nothing authoratative. Kinda doubt anyone has done such a study. All kinds of lyme things need studying.
I know of a case where lesions did disappear with treatment. Not saying this always happens.
Why are you still seeing ducks? All they do is quack and question your treatment, no matter whether it helps you or not. I think if they talked to Lazarus after he was raised from the dead, they would call it the placebo effect.
Posts: 8430 | From Not available | Registered: Oct 2000
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david1097
Frequent Contributor (1K+ posts)
Member # 3662
posted
Brian Fallon at columbia has been studying this. There was a presentation that was available on line that did show the spots disappear with ABX, apparently some do not.
Posts: 1184 | From north america | Registered: Feb 2003
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I agree about seeing ducks. Very hazardous to your emotional well being, not to mention the physical well being.
Why don't you pose the question to Lymenetters about whether or not their MRI's or Spect scans have gotten better with abx?
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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Michelle M
Frequent Contributor (1K+ posts)
Member # 7200
posted
Hi Brighty.
Agree with all -- lose the duck. It's so tiring. You really cannot educate the ones who are committed to their various diagnoses. (I.e., most of em.)
I have 11 frontal lobe lesions. I am hoping they go away. I have read some little blips stating that about half of them do. Some of my months and months of headaches make that hard to believe. My last MRI was in February 2005. Maybe next year I'll do another one. In treatment for 7 months now.
Here's one little "blip" regarding lesions. Unfortunately, they gave this group corticosteroids. Oops.
Michelle ______________________________________ [paragraphs broken up for ease of reading]
"MRI INSIGHTS" by David E. Egerter Ph.D. Published in Diagnostic Imaging, July 1992, pg. 63
Treatable, tick-borne disease should be considered in patients referred for non-specific neurological disorders. Magnetic resonance imaging can reveal pathology similar to the white matter lesions associated with multiple sclerosis in patients with a clinical history and serology compatible with neurologic Lyme disease. Although it has been observed in only a subset of these patients, the finding suggests that Lyme disease be considered in the diagnosis of patients referred for nonspecific neurologic complaints. While an effective treatment for MS remains elusive, neurologic Lyme disease typically responds well to antibiotic therapy.
"MS and Lyme disease can look pretty much the same on MRI," said Dr. Steven L. Galetta, an assistant professor of neurology at the Hospital of the University of Pennsylvania in Philadelphia. "Lyme disease should be considered part of the differential diagnosis when one sees multiple white matter lesions on MRI, particularly in endemic areas and in patients in the MS age group." Galetta is an author on one of two articles describing MRI-demonstrated white matter lesions in the brains of patients with clinical diagnoses of CNS Lyme disease (AJNR 1990;11:479-481 and 11:482-484).
These two articles -- the second of which was written by investigators from coastal New Jersey, in the heart of a Lyme disease endemic area -- constitute the first reports of such findings in the radiology literature. The HUP group also presented its work at the annual meeting of the American Society of Neuroradiology, held in March.
A single case with similar observations was reported by investigators from Emory University in Atlanta at last year's ASNR meeting. Lyme disease constitutes a new entity for most clinicians, let alone radiologists. The fundamental epidemiology of this complex illness has only been recognized since the early 1980s when researchers identified its causitive agent, the spirochete Borrelia burgdorferi.
Deer and possibly other wild mammals serve as reservoirs for the spirochete; humans contract the disease through the bites of infected ticks.
Endemic areas in the U.S. include the Northeast, particularly Massachusetts, Connecticut, New York, New Jersey, and Pennsylvania; Wisconsin and Minnesota in the Midwest; and northern California, Oregon and Washington. Like other spirochetal infections, which include syphilis, Lyme disease runs its course in several clinical stages.
While its three recognized stages can overlap or occur alone with periods of remission and exacerbation, Lyme disease usually begins with a pathognomonic skin rash, called erythema chronicum migrans, at the site of the tick bite.
The rash, which does not occur in some 20% to 40% of those infected, may be accompanied by headache, stiff neck, myalgia or neuralgia. Stage two, which follows by weeks to months, consists of recurrent or new neurologic problems, usually in the form of overt meningitis or radiculoneuropathy, or cardiac abnormalities.
Weeks to years later, patients may develop the arthritis or CNS abnormalities characteristic of stage three Lyme disease.
COMPLEX DISEASE COURSE Lyme disease patients, many of whom do not recall having been bitten by a tick, may first present to clinicians at any point in this complex disease course. Should Lyme disease be suspected, serological tests can be performed, but these are generally recognized to be problematic and inaccurate.
All this adds up to a great potential for Lyme disease to be overlooked or mistaken for other clinical entities. With neurologic abnormalities that can simulate MS or other demyelinating disease occurring in about 10% to 15% of Lyme disease patients, a substantial possibility exists that radiologists may be referred patients with neurologic complaints whose real problem remains unsuspected.
"If you see these abnormal foci in the white matter on MRI and you're not aware of Lyme disease, you might be tempted to call it MS. These people can really be debilitated," said Richard E. Fernandez, director of neuroradiology at the Community Medical Center in Toms River, NJ. Fernandez and co-investigators identified 17 patients who were referred for MRI brain studies over a 14-month period with clinically diagnosed Lyme disease.
Neurologic complaints that prompted referrals for MRI included headache, blurred vision, hearing loss and radiculopathy. One patient was referred with a diagnosis of transverse myelitis. Of the 17 patients, 14 had positive serum Lyme titer tests. A retrospective review of the MR scans, obtained with standard spin-echo sequences on a 1.5 tesla system, revealed focal areas or abnormal signal intensity in the images of six of the 14 serum-positive patients.
Mildly hypointense on T1-weighted images and markedly hyperintense on T2-weighted images, the foci ranged in size from 12 mm in a patient with a single brainstem lesion down to 2 mm, with most measuring in the 2 to 3 mm range. One 37-year-old patient imaged two months after a tick bite had 27 lesions counted. No mass effect was identified for any of the 61 total esions observed in the six patients.
While these observations reflect the bias of a small sample size, they suggest that the Lyme lesions tend to be subcortical in distribution, with a predilection for the white matter of the frontal and, to a lesser extent, the parietal lobes, Fernandez said.
Some of the lesions had the appearance of high-convexity, dilated Virchow-Robin spaces, rarely observed structures that are normally associated with the aging brain. Although some lesions had periventricular locations, the small size and subcortical distribution of the majority might help distinguish CNS Lyme disease from MS in a differential diagnosis, Fernandez said.
The high incidence of MR-positive studies has held up as the Toms River group continues to collect cases for an expanded series. This finding is not surprising given the large number of Lyme disease cases occurring in the two counties served by his group, Fernandez said.
"Lyme disease is a serious problem in this area," he said. "In our high schools you see kids walking around with heparin locks in their arms so they can take IV antibiotics and keep going to school. Maybe some of the lesions I'm seeing aren't due to Lyme disease, but I'm convinced that the majority are."
When the patient failed to respond to intravenous antibiotic therapy, a second MRI study revealed new lesions. Because of the patient's worsening condition, the team performed a stereotaxic CT-guided biopsy of a contrast-enhancing nodule in the left frontal lobe, which yielded spirochetes morphologically similar to the Lyme organism.
Supplementing subsequent courses of IV antibiotic therapy with corticosteroids dramatically improved the patient's neurologic status, and a follow-up exam 13 months after presentation showed no abnormal enhancement and resolution of many of the lesions.
Cautioning that they have described only a single case, Rafto said that more experience will be necessary to define the true imaging appearance of Lyme disease. "Lyme disease is endemic in many areas and you're going to see these patients," he said. "Most of them are going to be negative but you should watch for something that looks unusual.
In a situation where you see multiple abnormal areas of signal alteration and enhancing lesions, it should bring to mind other entities besides the ones that commonly come up. You may need to go back to the clinician for additional history and say, 'Look, Lyme disease, for example, can do this.'"
At the 1989 ASNR meeting, Dr. Susan B. Peterman, an assistant professor of radiology at Emory University, described a 41-year-old woman who had presented with optic neuritis and whose subsequent MRI study was consistent with MS.
When her laboratory findings came back atypical for MS, the woman was further questioned and revealed that after having been in a wooded area, she had developed a rash, which preceeded the optic neuritis. Upon testing serum-positive for Lyme disease, the woman was put on IV antibiotics with some improvement.
The case raises two interesting considerations, Peterman said. The first is that perhaps patients with atypical MS or with MS and a history of being in a tick-infested area should be tested for Lyme disease. The second is that, with the close resemblance of the suspected Lyme disease lesions to MS plaques, the two diseases may have a similar etiology, with MS occurring secondary to infection with an as yet unidentified spirochete.
Such a hypothesis has recently been proposed by British investigators (Lancet 1986;1:815-819 and 2:75), she said. "Some people may say hogwash, but it's still interesting to keep in the back of your mind," Dr. Peterman said."
Posts: 3193 | From Northern California | Registered: Apr 2005
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NP40
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My son's MRI showed the white focal matter lesions in Oct. 04. His latest MRI taken on 10/25/05 was clear. One year of abx did the trick.
Posts: 1632 | From Northern Wisconsin | Registered: Jan 2005
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Boomerang
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Wonderful news for your son..........!
Posts: 1366 | From Southeast | Registered: Sep 2005
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