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Lyme neuroborreliosis-associated cerebrovascular events in the Finnish endemic area

      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

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      References

        • Hildenbrand P.
        • Craven D.E.
        • Jones R.
        • Nemeskal P.
        Lyme Neuroborreliosis: manifestations of a rapidly emerging zoonosis.
        AJNR Am. J. Neuroradiol. 2009; 30: 1079-1087
        • Stanek G.
        • Strle F.
        Lyme borreliosis-from tick bite to diagnosis and treatment.
        FEMS Microbiol. Rev. 2018; 42: 233-258
        • Bacon R.M.
        • Kugeler K.J.
        • Mead P.S.
        Surveillance for Lyme disease - United States, 1992-2006.
        MMWR Surveill. Summ. 2008; 57: 1-9
        • Seelen M.
        • van den Wijngaard I.R.
        • Rundervoort R.S.
        Cerebral vasculitis and stroke due to Lyme neuroborreliosis: a favorable clinical outcome after early antibiotic treatment.
        J. Neurol. Sci. 2017; 375: 165-166
        • Topakian R.
        • Stieglbauer K.
        • Nussbaumer K.
        • Aichner F.T.
        Cerebral vasculitis and stroke in Lyme neuroborreliosis. Two case reports and review of current knowledge.
        Cerebrovasc. Dis. 2008; 26: 455-461
        • Moreno Legast G.
        • Schnider A.
        • Nicastro N.
        Ischemic stroke: do not forget Lyme Neuroborreliosis.
        Case Rep Neurol Med. 2018; 2018: 1720725
        • Zajkowska J.
        • Garkowski A.
        • Moniuszko A.
        • Czupryna P.
        • Ptaszyńska-Sarosiek I.
        • Tarasów E.
        • et al.
        Vasculitis and stroke due to Lyme neuroborreliosis - a review.
        Infect Dis (Lond). 2015; 47: 1-6
        • Almoussa M.
        • Goertzen A.
        • Fauser B.
        • Zimmermann C.W.
        Stroke as an unusual first presentation of Lyme disease.
        Case Rep Neurol Med. 2015; 2015: 389081
        • Li S.
        • Vytopil M.
        • Hreib K.
        • Craven D.E.
        Lyme disease presenting as multiple ischaemic strokes.
        Pract. Neurol. 2015; 15: 284-288
        • Schwenkenbecher P.
        • Pul R.
        • Wurster U.
        • Conzen J.
        • Pars K.
        • Hartmann H.
        • et al.
        Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization.
        BMC Infect. Dis. 2017; 17: 90
        • Zhang Y.
        • Lafontant G.
        • Bonner F.J.
        Lyme neuroborreliosis mimics stroke: a case report.
        Arch. Phys. Med. Rehabil. 2000; 81: 519-521
        • Scheid R.
        • Hund-Georgiadis M.
        • von Cramon D.Y.
        Intracerebral haemorrhage as a manifestation of Lyme neuroborreliosis?.
        Eur. J. Neurol. 2003; 10: 99-101
        • Jacobi C.
        • Schwark C.
        • Kress B.
        • Hug A.
        • Storch-Hagenlocher B.
        • Schwaninger M.
        Subarachnoid hemorrhage due to Borrelia burgdorferi-associated vasculitis.
        Eur. J. Neurol. 2006; 13: 536-538
        • Oschmann P.
        • Dorndorf W.
        • Hornig C.
        • Schäfer C.
        • Wellensiek H.J.
        • Pflughaupt K.W.
        Stages and syndromes of neuroborreliosis.
        J. Neurol. 1998; 245: 262-272
        • Mygland A.
        • Ljøstad U.
        • Fingerle V.
        • Rupprecht T.
        • Schmutzhard E.
        • Steiner I.
        EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis.
        Eur. J. Neurol. 2010; 17 (e1-4): 8-16
        • Hammers-Berggren S.
        • Gröndahl A.
        • Karlsson M.
        • von Arbin M.
        • Carlsson A.
        • Stiernstedt G.
        Screening for neuroborreliosis in patients with stroke.
        Stroke. 1993; 24: 1393-1396
        • Garkowski A.
        • Zajkowska J.
        • Zajkowska A.
        • Kułakowska A.
        • Zajkowska O.
        • Kubas B.
        • et al.
        Cerebrovascular manifestations of Lyme Neuroborreliosis-a systematic review of published cases.
        Front. Neurol. 2017; 8: 146
        • Wittwer B.
        • Pelletier S.
        • Ducrocq X.
        • Maillard L.
        • Mione G.
        • Richard S.
        Cerebrovascular events in Lyme Neuroborreliosis.
        J. Stroke Cerebrovasc. Dis. 2015; 24: 1671-1678
        • Sajanti E.
        • Virtanen M.
        • Helve O.
        • Kuusi M.
        • Lyytikäinen O.
        • Hytönen J.
        • et al.
        Lyme Borreliosis in Finland, 1995-2014.
        Emerg. Infect. Dis. 2017; 23: 1282-1288
        • Kortela E.
        • Kanerva M.
        • Puustinen J.
        • et al.
        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
        • Sacco L.
        • Kasner S.
        • Broderick J.
        • Caplan L.
        • Connors B.
        • Culebras A.
        • et al.
        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
        • Van Swieten J.C.
        • Koudstaal P.J.
        • Visser M.C.
        • Schouten H.J.
        • van Gijn J.
        Interobserver agreement for the assessment of handicap in stroke patients.
        Stroke. 1988; 19: 604-607
        • Younger D.S.
        • Coyle P.K.
        Central nervous system vasculitis due to infections.
        Neurol Clin. 2019; 37: 441-463
        • Back T.
        • Grünig S.
        • Winter Y.
        • Bodechtel U.
        • Guthke K.
        • Khati D.
        • et al.
        Neuroborreliosis-associated cerebral vasculitis: long-term outcome and health-related quality of live.
        J. Neurol. 2013; 260: 1569-1575
        • Borg R.
        • Dotevall L.
        • Hagberg L.
        • et al.
        Intravenous ceftriaxone compared with oral doxycycline for the treatment of Lyme neuroborreliosis.
        Scand. J. Infect. Dis. 2005; 37: 449-454
        • Sormunen J.J.
        • Penttinen R.
        • Klemola T.
        • Hänninen J.
        • Vuorinen I.
        • Laaksonen M.
        • et al.
        Tick-borne bacterial pathogens in southwestern Finland.
        Parasit. Vectors. 2016; 9: 168
        • Laaksonen M.
        • Klemola T.
        • Feuth E.
        • Sormunen J.J.
        • Puisto A.
        • Mäkelä S.
        • et al.
        Tick-borne pathogens in Finland: comparison of Ixodes ricinus and I. persulcatus in sympatric and parapatric areas.
        Parasit Vectors. 2018; 11: 556