Highlights
- •Lyme neuroborreliosis is a rare cause of stroke in endemic areas.
- ••Awareness is needed in endemic areas, as Lyme neuroborreliosis can easily be missed in routine stroke workup.
- •Patients diagnosed with Lyme neuroborreliosis associated stroke seem to have a good prognosis with appropriate treatment.
- •In the treatment of Lyme neuroborreliosis associated vasculitis the use of immunosupressive therapy should be considered.
Abstract
Objectives
Neuroborreliosis is a rare cause of cerebral vasculitis and stroke. The incidence
of Lyme borreliosis in Finland has been increasing in the last 20 years, so we expect
that Lyme neuroborreliosis–associated vasculitis can be a more common cause of stroke
in the future.
Materials & methods
We have retrospectively identified all adult patients (>16 years old) diagnosed with
borreliosis (A69.2 Lyme borreliosis), transient ischemic attack (TIA, G45), and ischemic
stroke (I63) at Helsinki University Hospital during 1.1.2014–31.10.2019 at our neurological
emergency department. Medical data and follow-up data were retrospectively collected
from medical records. Neuroborreliosis was diagnosed according to the European Federation
of Neurological Societies guidelines.
Results
We have identified 10 cases of neuroborreliosis–associated stroke or TIA and/or vasculitis.
Vasculitis as a manifestation of borreliosis was diagnosed in six patients of 1454
(0.4%) and stroke or TIA in nine (0.6%) of all borreliosis patients at Helsinki University
Hospital. Clinical outcomes for all our patients were good with a modified Rankin
scale (mRS) 0–2.
Conclusions
Lyme neuroborreliosis–associated vasculopathy and cerebrovascular events still remain
rare but should be considered especially in Lyme borreliosis endemic areas. Prognosis
is good with appropriate antibiotic treatment, but additional immunosupressive treatment
is sometimes needed.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Lyme Neuroborreliosis: manifestations of a rapidly emerging zoonosis.AJNR Am. J. Neuroradiol. 2009; 30: 1079-1087
- Lyme borreliosis-from tick bite to diagnosis and treatment.FEMS Microbiol. Rev. 2018; 42: 233-258
- Surveillance for Lyme disease - United States, 1992-2006.MMWR Surveill. Summ. 2008; 57: 1-9
- Cerebral vasculitis and stroke due to Lyme neuroborreliosis: a favorable clinical outcome after early antibiotic treatment.J. Neurol. Sci. 2017; 375: 165-166
- Cerebral vasculitis and stroke in Lyme neuroborreliosis. Two case reports and review of current knowledge.Cerebrovasc. Dis. 2008; 26: 455-461
- Ischemic stroke: do not forget Lyme Neuroborreliosis.Case Rep Neurol Med. 2018; 2018: 1720725
- Vasculitis and stroke due to Lyme neuroborreliosis - a review.Infect Dis (Lond). 2015; 47: 1-6
- Stroke as an unusual first presentation of Lyme disease.Case Rep Neurol Med. 2015; 2015: 389081
- Lyme disease presenting as multiple ischaemic strokes.Pract. Neurol. 2015; 15: 284-288
- Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization.BMC Infect. Dis. 2017; 17: 90
- Lyme neuroborreliosis mimics stroke: a case report.Arch. Phys. Med. Rehabil. 2000; 81: 519-521
- Intracerebral haemorrhage as a manifestation of Lyme neuroborreliosis?.Eur. J. Neurol. 2003; 10: 99-101
- Subarachnoid hemorrhage due to Borrelia burgdorferi-associated vasculitis.Eur. J. Neurol. 2006; 13: 536-538
- Stages and syndromes of neuroborreliosis.J. Neurol. 1998; 245: 262-272
- EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis.Eur. J. Neurol. 2010; 17 (e1-4): 8-16
- Screening for neuroborreliosis in patients with stroke.Stroke. 1993; 24: 1393-1396
- Cerebrovascular manifestations of Lyme Neuroborreliosis-a systematic review of published cases.Front. Neurol. 2017; 8: 146
- Cerebrovascular events in Lyme Neuroborreliosis.J. Stroke Cerebrovasc. Dis. 2015; 24: 1671-1678
- Lyme Borreliosis in Finland, 1995-2014.Emerg. Infect. Dis. 2017; 23: 1282-1288
- Oral doxycycline compared to intravenous ceftriaxone in the treatment of Lyme Neuroborreliosis: a multicenter, equivalence, randomized, Open-label Trial.Clin Infect Dis. 2021; 72: 1323-1331
- An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013; 44: 2064-2089
- Interobserver agreement for the assessment of handicap in stroke patients.Stroke. 1988; 19: 604-607
- Central nervous system vasculitis due to infections.Neurol Clin. 2019; 37: 441-463
- Neuroborreliosis-associated cerebral vasculitis: long-term outcome and health-related quality of live.J. Neurol. 2013; 260: 1569-1575
- Intravenous ceftriaxone compared with oral doxycycline for the treatment of Lyme neuroborreliosis.Scand. J. Infect. Dis. 2005; 37: 449-454
- Tick-borne bacterial pathogens in southwestern Finland.Parasit. Vectors. 2016; 9: 168
- Tick-borne pathogens in Finland: comparison of Ixodes ricinus and I. persulcatus in sympatric and parapatric areas.Parasit Vectors. 2018; 11: 556
Article info
Publication history
Published online: June 16, 2021
Accepted:
June 14,
2021
Received in revised form:
May 31,
2021
Received:
February 5,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
