1994 The long-term clinical outcomes of Lyme disease. A population-based retrospective cohort study.
Shadick NA; Phillips CB; Logigian EL; Steere AC; Kaplan RF; Berardi AB; Duray PH; Larson MG; Wright EA Ginsburg KS; Katz JN; Liang MH.
Annals of Internal Medicine 121(8 ): 560-7.
Patient 12 had had high fever, meningeal symptoms, and subsequent arthritis in 1982. She was noted to have a positive serologic test result for Lyme disease 4 years later and was treated with 2 weeks of parenteral penicillin. She later developed a progressive speech disorder, bradykinesia, and abnormal ocular motor function. Magnetic resonance imaging of the brain showed scattered white matter lesions in the hemispheres and pons, and she was diagnosed with supranuclear palsy. Lumbar puncture showed no selective concentration of antibody in the spinal fluid. Nevertheless, she was re-treated with 2 weeks of parenteral ceftriaxone in 1989 that had no effect on her neurologic symptoms. During the time of observation, this patient died. At autopsy, lymphoid mononuclear cells were observed surrounding the intracerebral vessels in one section. Using Dieterle silver stain, a spirochete was present in the cortex and another was exterior to a leptomeningeal vessel