The New Great Imitator – Neuropsychiatric Symptoms of Lyme Disease

2017 ◽  
Vol 41 (S1) ◽  
pp. S232-S232
Author(s):  
M.C. Cochat Costa Rodrigues ◽  
I. Moreira ◽  
M.J. Peixoto ◽  
C. Silveira
Keyword(s):  
Nervous System ◽  
Lyme Disease ◽  
Antibiotic Treatment ◽  
Mental Health Professionals ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Psychiatric Disease ◽  
The Central Nervous System ◽  
Competing Interest ◽  
Possible Cause

IntroductionLyme disease, caused by the spirochete Borrelia burgdorferri as recognized as a possible cause of multisystemic signals and symptoms, including symptomatology of the central as well as the peripheral nervous system.ObjectivesIdentification of neuropsychiatric symptoms associated with Lyme disease.MethodsLiterature review in the light of researched articles published in Pubmed/Medline as well as related bibliography.ResultsSince the identification of the etiology of syphilis in the early twentieth century, mental health professionals consider the fact that serious psychiatric symptoms can be caused by infections of the central nervous system and that early antibiotic treatment can prevent permanent neurological/psychiatric damage. Syphilis was known as “the great imitator” because its multiple manifestations mimic other known diseases. In recent years, a new epidemic, also with multiple manifestations emerged–Lyme disease, also known as the “new great imitator”. Like syphilis, Lyme disease may be associated with neuropsychiatric symptoms, which means that often these cases are initially referred for psychiatric services, before another diagnosis is made. The incorrect assessment of these patients as individuals with functional psychiatric disease can result in a delay in the start of antibiotic treatment and may cause serious neurological and psychiatric damage.ConclusionsAccording to the review, the authors propose that in the evaluation of acute psychiatric disease or atypical chronic disease, with poor therapeutic response, Lyme disease should be considered and ruled out, especially if there is epidemiological context and absence of psychiatric family antecedents.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Psychiatric Disturbance As a Presenting Symptom in Central Nervous Lymphoma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5415-5415
Author(s):  
Akanksha Sharma ◽  
Natalie Ertz-Archambault ◽  
Luke Mountjoy ◽  
Alyx Porter ◽  
Maciej M Mrugala
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Psychiatric Symptoms ◽  
Conflicts Of Interest ◽  
Neuropsychiatric Symptoms ◽  
B Cell Lymphoma ◽  
Psychiatric Disease ◽  
Cns Lymphoma ◽  
Psychiatric Disturbance ◽  
Cognitive Changes

Abstract Background: Central nervous system (CNS) lymphoma manifests as a highly aggressive non-Hodgkins lymphoma, either confined to the central nervous system or secondary to spread of systemic diffuse large B cell lymphoma. Rising incidence of CNS lymphoma has been observed, especially in elderly populations. Presentation depends on the burden and location of disease, with a varying spectrum of symptoms ranging from headaches and cognitive changes to focal neurological deficits and seizures. Neuropsychiatric presentation of CNS lymphoma has been seen and anecdotally reported but appears to be under-represented in the literature. In this retrospective review of patients with CNS lymphoma at MCA we report a cohort of patients who presented with primarily neuropsychiatric symptoms Methods: After receiving IRB approval, we retrospectively identified 135 patients with ICD 9 and 10 codes consistent with CNS lymphoma, seen at Mayo Clinic Arizona, between 1998-2018. Symptoms identified prior to presentation with the CNS component of the lymphoma were recorded with attention to those with depression, anxiety, agitation, psychosis, disinhibition, and apathy. Patients with long term premorbid psychiatric disease or symptoms that developed later in the course as a result the stressors of disease and treatment were excluded. Results: A total of 19 out of 136 patients (14%) were noted to have primarily neuropsychiatric symptoms prior to diagnosis of CNS lymphoma. Symptom onset to diagnosis of PCNSL ranged from 3 weeks to 11 months. The average age was 65, and 47% of subjects were male. Depression, apathy, agitation and features of parkinsonism were the most common neuropsychiatric symptoms identified, with psychosis and disinhibition being the least frequent. The majority of these patients had frontal lobe lesions (42%), although several also had multifocal disease at time of diagnosis. Improvement of neuropsychiatric disease was not explicitly discussed or noted in the treatment and post-treatment notes. In fact, we found it notable that follow up notes generally did not comment on these psychiatric symptoms at all, and there was no clear management plan separate from treating the disease process. Parkinsonian features were observed in 5 patients (26%), with onset range from 2 weeks to 29 months prior to PCNSL diagnosis. The associated lesions were mostly deep basal ganglia or corpus callosum except in one case of left parietal lobe tumor. Notably, all patients had resolution of their parkinsonism with treatment of the lymphoma. Conclusions: Neuropsychiatric symptoms are a rare but noteworthy presentation of CNS lymphoma, distinct from cognitive changes that have been previously described with this condition. There is an increasing awareness of neurological illness presenting as pure psychiatric disturbance, prompting exclusion of organic disease, particularly in elderly patients who present with new psychiatric complaints. Disclosures No relevant conflicts of interest to declare.

Neuro-Behçet's psychiatric symptoms

2016 ◽  
Vol 33 (S1) ◽  
pp. S371-S371
Author(s):  
F. Maduro ◽  
S. Neiva ◽  
C. Pissarra ◽  
F. Duarte ◽  
L. Marques
Keyword(s):  
Structural Changes ◽  
Psychiatric Symptoms ◽  
Brain Inflammation ◽  
Psychiatric Disease ◽  
Dysfunctional Family ◽  
The Central Nervous System ◽  
Competing Interest ◽  
Spect Scan ◽  
Ct And Mri

Neuro-Behçet (NB) results from inflammatory peri-vasculitis affecting the central nervous system. Non-specific neurological and psychiatric symptoms are rarely the first presentation and may difficult or delay diagnosis and treatment.We review, based on a case study and published literature, the psychiatric symptoms of NB when no clear evidence of neurologic disease activity is present.We present the case of a female patient, who was diagnosed NB at age 23 for recurrent meningo-encephalitis, that showed progressive behavioral changes, with increased impulsivity, disinhibition, hostility and self-neglect.Raised in a dysfunctional family, she ran away from home at 16, abandoned her studies, started abusing cannabinoids and showed an erratic life course.In 2015, because of increasing psychiatric symptoms, she was admitted to hospital and a complete neuropsychological evaluation showed that she had a significant decline from an above average premorbid cognitive function, specifically related to memory deficits. CT and MRI didn’t show typical signs of active disease. However, a SPECT scan showed hypo-perfusion of the frontal cortex compatible with the patient's symptoms.It is difficult to assess NB's activity as brain inflammation is only observed after structural changes are present. In this case the SPECT correlated well with psychiatric symptoms. The differential diagnosis includes organic pathology with psychiatric symptoms, psychiatric disease, personality disorders and substance abuse.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Psychiatric Symptoms due to Thyroid Disease in a Female Adolescent

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Nelly Capetillo-Ventura ◽  
Inmaculada Baeza
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Thyroid Hormone ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Female Adolescent ◽  
Normal Functioning ◽  
Pituitary Thyroid Axis ◽  
Thyroid Axis ◽  
The Central Nervous System

The hypothalamic-pituitary-thyroid axis is involved in the production of thyroid hormone which is needed to maintain the normal functioning of various organs and systems, including the central nervous system. This study reports a case of hypothyroidism in a fifteen-year-old female adolescent who was attended for psychiatric symptoms. This case reveals the importance of evaluating thyroid function in children and adolescents with neuropsychiatric symptoms.

scholarly journals Autoantibodies in Neuropsychiatric Systemic Lupus Erythematosus (NPSLE): Can They Be Used as Biomarkers for the Differential Diagnosis of This Disease?

2021 ◽  
Author(s):  
Elias Manca
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Central Nervous System ◽  
Nervous System ◽  
Differential Diagnosis ◽  
Human Body ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Systemic Lupus ◽  
Neuropsychiatric Systemic Lupus Erythematosus ◽  
The Central Nervous System

AbstractSystemic lupus erythematosus is a complex immunological disease where both environmental factors and genetic predisposition lead to the dysregulation of important immune mechanisms. Eventually, the combination of these factors leads to the production of self-reactive antibodies that can target any organ or tissue of the human body. Autoantibodies can form immune complexes responsible for both the organ damage and the most severe complications. Involvement of the central nervous system defines a subcategory of the disease, generally known with the denomination of neuropsychiatric systemic lupus erythematosus. Neuropsychiatric symptoms can range from relatively mild manifestations, such as headache, to more severe complications, such as psychosis. The evaluation of the presence of the autoantibodies in the serum of these patients is the most helpful diagnostic tool for the assessment of the disease. The scientific progresses achieved in the last decades helped researchers and physicians to discover some of autoepitopes targeted by the autoantibodies, although the majority of them have not been identified yet. Additionally, the central nervous system is full of epitopes that cannot be found elsewhere in the human body, for this reason, autoantibodies that selectively target these epitopes might be used for the differential diagnosis between patients with and without the neuropsychiatric symptoms. In this review, the most relevant data is reported with regard to mechanisms implicated in the production of autoantibodies and the most important autoantibodies found among patients with systemic lupus erythematosus with and without the neuropsychiatric manifestations.

scholarly journals Antibiotic treatment of abscesses of the central nervous system.

BMJ ◽  
1977 ◽  
Vol 2 (6093) ◽  
pp. 985-987 ◽  
Author(s):  
J de Louvois ◽  
P Gortvai ◽  
R Hurley
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Antibiotic Treatment ◽  
The Central Nervous System

Cerebrospinal Fluid Cytology of Lyme Neuroborreliosis: A Report of 3 Cases with Literature Review

2015 ◽  
Vol 59 (4) ◽  
pp. 339-344 ◽  
Author(s):  
Juan Xing ◽  
Lisa Radkay ◽  
Sara E. Monaco ◽  
Christine G. Roth ◽  
Liron Pantanowitz
Keyword(s):  
Central Nervous System ◽  
Flow Cytometry ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Lyme Disease ◽  
B Cell ◽  
Plasma Cells ◽  
Lyme Neuroborreliosis ◽  
Chain Analysis ◽  
The Central Nervous System

Lyme disease can affect the central nervous system causing a B-cell-predominant lymphocytic pleocytosis. Since most reactions to infection in the cerebrospinal fluid (CSF) are typically T-cell predominant, a B-cell-predominant lymphocytosis raises concern for lymphoma. We present 3 Lyme neuroborreliosis cases in order to illustrate the challenging cytomorphological and immunophenotypic features of their CSF specimens. Three male patients who presented with central nervous system manifestations were diagnosed with Lyme disease. The clinical presentation, laboratory tests, CSF cytological examination and flow-cytometric studies were described for each case. CSF cytology showed lymphocytic pleocytosis with increased plasmacytoid cells and/or plasma cells. Flow cytometry showed the presence of polytypic B lymphocytes with evidence of plasmacytic differentiation in 2 cases. In all cases, Lyme disease was confirmed by the Lyme screening test and Western blotting. In such cases of Lyme neuroborreliosis, flow cytometry of CSF samples employing plasmacytic markers and cytoplasmic light-chain analysis is diagnostically helpful to exclude lymphoma.

scholarly journals Neurobrucellosis mimicking primary vasculitis of the central nervous system: we should perform a metagenomic analysis of the cerebrospinal fluid prior to brain biopsy

2021 ◽  
Author(s):  
Marina Barrionuevo Mathias ◽  
Fernando Gatti ◽  
Gustavo Bruniera ◽  
Vitor Paes ◽  
Gisele Sampaio Silva ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Psychiatric Symptoms ◽  
Brain Mri ◽  
Genetic Material ◽  
Clinical Manifestations ◽  
Brain Biopsy ◽  
Metagenomic Analysis ◽  
Normal Brain ◽  
The Central Nervous System

Context Primary angiitis of the central nervous system (PACNS) is characterized by the inflammation of small and medium CNS arteries; the clinical manifestations include headache, cognitive impairment and focal neurological deficits. The gold standard test for diagnosis is brain biopsy. Neurobrucellosis is an infection associated with cattle farming, which leads to neurological and psychiatric symptoms. We report a case of neurobrucellosis mimicking PACNS. Case report Male, 32 years old, with fever, headache, dizziness and cognitive impairments for 30 days. History of stroke 2 years before, with mild sequelae right hemiparesis; investigation showed suspected intracranial dissection. On physical examination, he had apathy, preserved strength, reduced reflexes with plantar flexor responses. General laboratory tests, autoantibodies and serology were normal. Brain MRI showed deep left nucleocapsular gliosis and cerebral angiography revealed stenosis of the ICA and MCA. CSF showed 42 cells/ mm³, glucose 46 mg/dL, protein 82 mg/dL. Blood PCR was negative for Brucella. Immunophenotyping of the CSF and PET-CT excluded neoplasia. Brain biopsy was inconclusive for vasculitis. Metagenomic analysis of the CSF detected 78% of Brucella genetic material. Serum agglutination test was 1:40 for brucella. Conclusions PACNS is diagnosed by exclusion. The patient filled criteria for possible PACNS, image compatible with vascular stenosis, but inconclusive brain biopsy. Brucellosis is an endemic disease in underdeveloped countries that can present as CNS vasculitis. Metagenomic analysis allows the detection of different pathogens using a single method. The case illustrates the use of metagenomics in rare diseases characterized by vasculitis, with change in clinical outcomes and conduct.

scholarly journals Liaison psychiatry in a central nervous system tumor service

2015 ◽  
Vol 2 (2) ◽  
pp. 88-92
Author(s):  
Alex C.N. Holmes ◽  
Sophia J. Adams ◽  
Scott Hall ◽  
Mark A. Rosenthal ◽  
Katharine J. Drummond
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Neuropsychiatric Symptoms ◽  
Lower Grade ◽  
Central Nervous System Tumor ◽  
Liaison Psychiatry ◽  
Cns Tumor ◽  
Treatment Information ◽  
Psychological Medicine ◽  
The Central Nervous System

AbstractBackgroundTumors of the central nervous system (CNS) have physical and psychological effects that commonly interact and change over time. Although well suited to addressing problems at the interface between physical and psychological medicine, the role of the consultation-liaison psychiatrist has not been previously described in the management of these patients. The purpose of this paper is to summarize the experience of psychiatry liaison attachment within a CNS tumor service and to reflect on its utility within a complex multidisciplinary environment.MethodsA retrospective file review was performed on all cases seen by a psychiatrist in a CNS tumor service over the previous 5 years. A simple thematic inductive analysis was conducted of the common problems experienced by patients and their management by the psychiatrist and within the team.ResultsFive common themes were identified: (i) facilitating adaptation to diagnosis; (ii) supporting living with lower-grade tumors; (iii) managing mental disorders; (iv) neuropsychiatric symptoms of tumor progression; and (v) grief and uncertainty in the advanced stages of illness. The capacity of the psychiatrist to understand and integrate the clinical, pathological, radiological, and treatment information, in communication with colleagues, helped address these challenges.ConclusionsPsychological challenges in CNS tumor patients have both psychological and neurological underpinnings. In our experience, the addition of a liaison psychiatrist to a CNS tumor service was efficient and effective in improving patient management and led to enhanced communication and decision-making within the team.

scholarly journals Long COVID neuropsychological deficits after severe, moderate or mild infection

2021 ◽  
Author(s):  
P. Voruz ◽  
G. Allali ◽  
L. Benzakour ◽  
A. Nuber-Champier ◽  
M. Thomasson ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Severe Acute Respiratory Syndrome ◽  
Respiratory Symptoms ◽  
Psychiatric Symptoms ◽  
Olfactory Dysfunction ◽  
Neuropsychological Deficits ◽  
Post Discharge ◽  
The Central Nervous System

ABSTRACTBackgroundThere is growing awareness that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can include long-term neuropsychological deficits, even in its mild or moderate respiratory forms.MethodsStandardized neuropsychological, psychiatric, neurological and olfactory tests were administered to 45 patients (categorized according to the severity of their respiratory symptoms during the acute phase) 236.51 ± 22.54 days post-discharge following SARS-CoV-2 infection.ResultsDeficits were found in all the domains of cognition and the prevalence of psychiatric symptoms was also high in the three groups. The severe performed more poorly on long-term episodic memory and exhibited greater anosognosia. The moderate had poorer emotion recognition, which was positively correlated with persistent olfactory dysfunction. The mild were more stressed, anxious and depressed.ConclusionThe data support the hypothesis that the virus targets the central nervous system (and notably the limbic system), and support the notion of different neuropsychological phenotypes.

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