1. Spirochete infections Boreliosis (Lyme disease) Borrelia burgdorferi Syphylis (Lues) Treponema pallidum

2. Borrelia burgdorferi

3. Summary of reported cases of Lyme disease in the United States. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079- 1087 ©2009 by American Society of Neuroradiology

4. Lyme disease

5. Skin lesion After tick bite

6. Erythema migrans rash with the typical target appearance that is virtually diagnostic of Lyme disease. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079- 1087 ©2009 by American Society of Neuroradiology

7. Lyme disease

8. Clinical feature 10-15% patients with untreated borreliosis – neuroborelliosis Primary location – ganglia od posterior roots, nerv roots, leptomeninges (macacus rhesus) Europe –– B. garinii

9. Clinical feature Periferal NS Sensory symptoms Painful radiculitis Painful lymphocytic meningoradiculitis – with/without paresis (Garin-Bujadoux- Bannwart syndróm) Facial palsy Pain – sharp, during night, weeks – months

10. Clinical feature Central NS Subsequent to the tick bite inoculation – B. reach reach the CNS Hematogenously or retrogradely via periferal nerves Encefalitis Cranial neuritis Motor or sensitive radikuloneuroitis Encefalomyelitis - rare

11. Clinical feature late presentation Dementia – often in patients with artritis Desorientation, confusion, memory problems, cognitive dysfunction Chronic radikuloneuropathy – parestesia of acral parts, pain, EMG – axonal lesion

12. Diagnosis EMG – axonal lesion CSF: pleocytosis – Ly,  proteins intratecal antibodies IgM, IgG against BB PCR

13. Facial neuritis. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079- 1087 ©2009 by American Society of Neuroradiology

14. Evolving cranial neuritis. Enhancement n. III, V l.dx., VII l. sin. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079- 1087 ©2009 by American Society of Neuroradiology

15. A 50-year-old woman with a history of tick bite and erythema migrans rash treated with doxycycline, who had recurrent erythema migrans rash with headache, fever, nausea, and nuchal rigidity. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079- 1087 ©2009 by American Society of Neuroradiology

16. A 74-year-old man with 2-year cognitive decline and memory loss. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079- 1087 ©2009 by American Society of Neuroradiology

17. A 56-year-old woman with neck, bilateral shoulder, and bilateral arm pain. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079- 1087 ©2009 by American Society of Neuroradiology

18. A 17-year-old boy with right papilledema and orbital pain and rule out pseudotumor. Hildenbrand P et al. AJNR Am J Neuroradiol 2009;30:1079- 1087 ©2009 by American Society of Neuroradiology

19. Boreliosis Th: Doxycycline (2x100 mg/D, 2T) CSF negat. i.v. ceftriaxone – likvor pozit.

20. Syphilis (Lues) 1/3 nontreated patients – neurovascular complications of syphylis

21. Neurosyphilis Patogenesis Perivascular infiltration of the meninges, focal meningeal inflammation – formation of hypertrophic meninges, or gumma, Inflammatory cells invide blood vessel wal – arteritis (luminal occlusion) Parenchymal involvement – gliosis in late stages Ly infiltration of preganglionic portion of dorsal roots and posterior columns atrophy of posterior columns

22. Neurosyfilis – meningitis CSF Ly, ↓ Glu,  proteins Pozit. VDRL test

23. Neurosyfilis – meningovascular Endarteritis – small and medium vessels (MCA) – can be stroke etiology in young people !!! Focal signs AG: nerrowing of arteries MRI: multiple infarcts Spinal artery – transversal myelitis

25. Demencia paralytica Progressive paralysis Decreased cognitive functions, memory problems, pupils abnormality

27. Tabes dorsalis Paresthesias in root distribution Decreased proprioception Spinal ataxia Argyll-Roberts pupils

30. Acquired immunodeficiency syndrom (AIDS) Human immunodeficiency virus (HIV) I. stage Acute infection - 2. - 3. weeks after infection by HIV Symptoms like flu, or mononukleosis Acute retroviral syndrom

31. Stage II Period without symptoms – 2-10 years or more Decreased imunity in this period

32. Stage III, IV III – generalized lymphadenopathy, enlargement of LN IV- stage of AIDS Weakened immune system fails Fewer, lost of weight, weakness, fatigue, muscle atrophy

33. Acquired immunodeficiency syndrom (AIDS) IV stage - symptoms of lesion of PNS and CNS Aseptic meningitis Cognitive decline Myelopathy Neuropathy (inflammatory demyelinating polyneuropathy, mononeuropathy, plexopathy) Myopathy – myositis

34. AIDS dementia complex (ADC) T2- MRI: Enlargement of ventricles Hyperintensity in subcortical white matter of frontal lobes Brain atrophy

35. HIV Opportunistic Infections People with advanced HIV infection are vulnerable to infections and malignancies that are called 'opportunistic infections' because they take advantage of the opportunity offered by a weakened immune system. Bacterial diseases such as tuberculosis, Mycobacterium avium complex, bacterial pneumonia and septicaemia (blood poisoning) Protozoal diseases such as toxoplasmosis, microsporidiosis, cryptosporidiosis, isopsoriasis and leishmaniasis

36. HIV Opportunistic Infections Fungal diseases such as Pneumocystis pneumonia, candidiasis, cryptococcosis and penicilliosis Viral diseases such as those caused by cytomegalovirus, herpes simplex and herpes zoster virus HIV-associated malignancies such as Kaposi's sarcoma, lymphoma and squamous cell carcinoma.