MRI differential

[cave76]

Abstract:

It is widely accepted that magnetic resonance imaging (MRI) findings are not totally specific for the diagnosis of multiple sclerosis. White matter lesions that mimic those of multiple sclerosis may be detected in both normal volunteers and patients harbouring different diseases. "

Virtually all the characteristic features of multiple sclerosis are sometimes encountered in other conditions affecting predominantly the white matter. Different conditions such as vasculitis, subcortical atherosclerotic leukoencephalopathy, Lyme disease, or acute disseminated encephalomyelitis can be virtually indistinguishable from multiple sclerosis on conventional MR images.

Also the FLAIR technique adds little to the differential diagnosis. The calculation of magnetisation transfer ratio (MT ratio) may be useful to better characterise some entities, such as vasculitis, from multiple sclerosis.

Differential diagnosis of multiple sclerosis: contribution of magnetic resonance techniques.
Authors: Triulzi F, Scotti G
Source: J Neurol Neurosurg Psychiatry 1998 May;64 Suppl 1:S6-14
Organization:  Department of Neuroradiology, Scientific Institute H S Raffaele, Milan, Italy. triulzi.***@****

[cave76]

Of course, since the common theory that Bb isn't readily found in the blood may be the problem and  may be the reason that flow cytometry isn't used.

Here's another article:
"A simple method for the detection of live Borrelia spirochaetes in human blood using classical microscopy techniques"

http://www.biomedicalreports.org/index.php?journal=bbr&page=article&op=view&path%5B0%5D=98

Again with the blood. (grin)

[cave76]

I'm going down the rabbit hole again, Wonko. (grin) I read the entire article you linked and found something that I had to look up---- flow cytometry. (http://en.wikipedia.org/wiki/Flow_cytometry)

Following that kernel led me to some PubMed articles talking about borrelialcidal antibodies. One is:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC120016/

Have  you seen anything about that? I wonder if it's the expense of it or other flaws in that method that has kept it from being  used.

[wonko]

A related reference that may be of interest:

Lyme Neuroborreliosis: Manifestations of a Rapidly Emerging Zoonosis
Author(s): Hildenbrand, P (Hildenbrand, P.)[ 1,6 ] ; Craven, DE (Craven, D. E.)[ 2,5 ] ; Jones, R (Jones, R.)[ 3,6 ] ; Nemeskal, P (Nemeskal, P.)[ 4,5 ]
Source: AMERICAN JOURNAL OF NEURORADIOLOGY  Volume: 30   Issue: 6   Pages: 1079-1087   DOI: 10.3174/ajnr.A1579   Published: JUN-JUL 2009

Abstract: Lyme disease has a worldwide distribution and is the most common vector-borne disease in the United States. Incidence, clinical manifestations, and presentations vary by geography, season, and recreational habits. Lyme neuroborreliosis (LNB) is neurologic involvement secondary to systemic infection by the spirochete Borrelia burgdorferi in the United States and by Borrelia garinii or Borrelia afzelii species in Europe. Enhanced awareness of the clinical presentation of Lyme disease allows Inclusion of LNB in the imaging differential diagnosis of facial neuritis, multiple enhancing cranial nerves, enhancing noncompressive radiculitis, and pediatric leptomeningitis with white matter hyper-intensities on MR imaging. The MR imaging white matter appearance of successfully treated LNB and multiple sclerosis display sufficient similarity to suggest a common autoimmune pathogenesis for both. This review highlights differences in the epidemiology, clinical manifestations, diagnosis, and management of Lyme disease in the United States, Europe, and Asia, with an emphasis on neurologic manifestations and neuroimaging.