When dementia can be cured…

<h3></h3> Here we report a case of Lyme neuroborreliosis presenting as a rapidly progressive dementia. There are few such case reports in the literature, even fewer meeting definite European Federation of Neurological Societies diagnostic criteria, as this case does. Remarkably, following treatment with ceftriaxone, 30 months from symptom onset, the patient has returned to normal baseline functioning, including the ability to drive. A 70-year old female presented with an 18-month history of progressive cognitive decline including variable attention, perseveration and dysphasia, together with reduced mobility, pyramidal leg weakness, incontinence and possible seizures. MR imaging demonstrated non-enhancing progressive leukoencephalopathy with an indeterminate thoracic spinal cord lesion. An extensive blood screen and PET CT, excluded systemic inflammation or malignancy. CSF analysis revealed a lymphocytic pleocytosis, high protein and low glucose. Paired CSF and serum immunoblot analysis at the reference laboratory confirmed intra-thecal production of specific anti-borrelial antibodies. Ceftriaxone treatment saw an improvement in her MoCA score from 6 to 30 with continued progress thereafter. The relevance of the spinal cord lesion is still not entirely clear, however, improvement in interval imaging suggests it is related to the presentation. In endemic areas, Lyme neuroborreliosis should be considered as a rare, treatable cause of dementia.