{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T00:48:38Z","timestamp":1777769318452,"version":"3.51.4"},"reference-count":8,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,4,15]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>A man in his 70s presented with a subacute akinetic\u2013rigid syndrome consistent with secondary parkinsonism, characterised by axial rigidity, bradykinesia, hypophonia, gait initiation failure and constitutional symptoms. MRI demonstrated symmetrical T2\/FLAIR hyperintensities involving the brainstem, diencephalon and dentate nuclei. Cerebrospinal fluid (CSF) showed lymphocytic pleocytosis, markedly elevated protein and low glucose, together with increased CXCL13 levels (exact quantitative value unavailable from the external laboratory report). Serum Borrelia IgG was positive and confirmed by western blot. No alternative infectious, autoimmune or neoplastic aetiology was identified. The overall picture supported a diagnosis of probable late neuroborreliosis according to EFNS criteria. Treatment with intravenous ceftriaxone followed by oral doxycycline resulted in rapid improvement. At 6-month follow-up, he was clinically asymptomatic and brain MRI demonstrated complete radiological resolution. This case highlights neuroborreliosis as an uncommon but reversible cause of secondary parkinsonism\/parkinsonism mimic and underscores the diagnostic relevance of its distinctive imaging pattern.<\/jats:p>","DOI":"10.1136\/bcr-2025-271239","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:15:43Z","timestamp":1777479343000},"page":"e271239","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Reversible subacute secondary parkinsonism due to neuroborreliosis with characteristic MRI evolution"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2868-4166","authenticated-orcid":false,"given":"Jesus","family":"Ramirez Sanchez-Ajofrin","sequence":"first","affiliation":[{"name":"Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain"},{"name":"Movement Disorders Unit, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nagore","family":"Sanzo Esnaola","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco J","family":"Castelbon Fernandez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Community of Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9155-1438","authenticated-orcid":false,"given":"Marta","family":"Gonz\u00e1lez-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain"},{"name":"Group of Neurodegenerative Diseases, Hospital 12 de Octubre, Madrid, Community of Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"2026042909152357000_19.4.e271239.1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25389"},{"key":"2026042909152357000_19.4.e271239.2","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1212\/CON.0000000000001015","article-title":"Neurologic Complications of Lyme Disease","volume":"27","author":"Roos","year":"2021","journal-title":"Continuum (Mount Lawley)"},{"key":"2026042909152357000_19.4.e271239.3","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1007\/s00415-020-10188-9","article-title":"Brainstem encephalitis in neuroborreliosis: typical clinical course and distinct MRI findings","volume":"268","author":"Pfefferkorn","year":"2021","journal-title":"J Neurol"},{"key":"2026042909152357000_19.4.e271239.4","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1159\/000116399","article-title":"Extrapyramidal features in central Lyme borreliosis","volume":"29","author":"Kohlhepp","year":"1989","journal-title":"Eur Neurol"},{"key":"2026042909152357000_19.4.e271239.5","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1212\/WNL.0b013e318211c39a","article-title":"A prospective study on the role of CXCL13 in Lyme neuroborreliosis","volume":"76","author":"Schmidt","year":"2011","journal-title":"Neurology (ECronicon)"},{"key":"2026042909152357000_19.4.e271239.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2009.02862.x"},{"key":"2026042909152357000_19.4.e271239.7","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw299"},{"key":"2026042909152357000_19.4.e271239.8","first-page":"659","article-title":"Lyme borreliosis","volume":"12","author":"Stanek","year":"2012","journal-title":"Lancet Infect Dis"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271239","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:15:44Z","timestamp":1777479344000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271239"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":8,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,29]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bcr-2025-271239"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271239","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}