Multi-infarct dementia and Alzheimer disease, contribution of cerebral circulation ultrasonography to pathogenesis and differential diagnosis. Value of microembolisation.

OBJECTIVES: Dementias are one of the most serious health and socioeconomic issues. Multi-infarct dementia (MID) and Alzheimer´s type dementia (AD) exhibit differences in cerebrovascular blood flow velocity profiles and in presence of microemboli, detected by transcranial Doppler sonography. MATERIAL AND METHODS: A group of 77 persons was divided into 4 subgroups: 1. subgroup of patients with MID (n=19; 10 male and 9 female, mean age was 74.32±8.30 years); 2. subgroup of patients with AD (n=19; 11 male and 8 female, mean age was 70.37±87.85 years); 3. subgroup of patients with hypertension (n=19; 11 male and 8 female, age adjusted) and 4. sex and age adjusted control group (CG) of 20 persons without hypertension or other serious risk factors. The duplex ultrasonographic examination of extracranial and intracranial circulation was preceded by neurologic, neuropsychological and psychiatric examination. The presence of microemboli was determined using Multi Dop X2 device (maker DWL), 60 minutes monitoring. All patients underwent brain computer tomography (CT) or magnetic resonance imaging (MRI). RESULTS: We found significantly higher incidence (68.4%, p=0.5267) of asymptomatic microemboli in ACM in the group of patients with MID compared to the AD group, the group of patients with hypertension and CG. CONCLUSION: The occurrence of "asymptomatic" emboli in the middle cerebral artery in patients with multi-infarct dementia is higher in the current study. Although these microemboli do not cause immediate symptoms, the evidence suggests, that they may be a risk factor for cognitive impairment, especially for multi-infarct dementia.

The genospecies B. burgdorferi s.l., isolated from ticks and from neurological patients with suspected Lyme borreliosis.

OBJECTIVE: Lyme borreliosis (LB) is the most disseminated tick-borne disease in the Northern hemisphere, and infestation with ticks is one of the essential factors influencing transmission of the disease to humans. This work intends to compare the occurrence of borrelia circulating in indigenous ticks and in patients suffering from neurological diseases. MATERIALS & METHODS: The total of 660 nymphs and 567 adult ticks from the Bratislava and Kosice areas was examined over the years 2001-2004, and the cerebrospinal fluid (CSF) of 82 neurological patients suffering from suspected Lyme borreliosis infection was investigated in the 2007-2009 period, using the polymerase chain reaction method (PCR). RESULTS: PCR investigation proved presence of borrelia in 23.3% of the total 1227 ticks; of these, co-infection was found in 2.7% of all ticks. Borrelia garinii (9.9%) and B. valaisaina (9.2%) were the prevalent types. PCR investigation of the CSF samples of 32 patients with clinically diagnosed Lyme borreliosis showed the presence of B. burgdorferi s.l. in 17 cases. Positive results were found also in patients with unclear or different diagnoses. In cases where the genospecies could be identified, B. garinii was most frequently found (8x), followed with B. burgdorferi s.s. (4×) and B. afzelii (3×). CONCLUSIONS: The high infestation level of ticks with borrelia, mainly with B. garinii which is the most-often documented borrelia species identified in neurological patients, is indicative of a high risk of this contamination in Slovakia. B. garinii were found also in our neuroborreliosis patients, whereas their proof in the CSF of patients with suspected neuroborreliosis or with a different clinical diagnosis pointed upon their persistence after an infectious experience. However, knowledge of not only the genospecies but also of the genotypes capable of eliciting an invasive disorder would be necessary for better clarification of the relationship between borrelia and their peccant capacity. Identification of the invasive borrelia types circulating in nature, and clarification of the vector vs. human infection incidence relationship is of importance from the aspect of detailed knowledge of the epidemiology of this disease.

Infection with B. burgdorferi s.l., and the CNS demyelinating disease. A case report.

The work describes three cases of patients at various ages, diagnosed for CNS demyelinating disease. The presence of specific antibodies to B. burgdorferi sensu lato, and findings of B. burgdorferi s.l. DNA, identified in one case as the genospecies B. garinii in the liquor, indicated previous experience with the infection. Presumably, persistence of borrelia in the organism could act as one of the autoimmune process triggers, resulting in the demyelinating disease.