Cerebral Vasculitis and Stroke in Lyme Neuroborreliosis

Topakian, Raffi; Stieglbauer, Karl; Nußbaumer, Karin; Aichner, F.

doi:10.1159/000155982

Cited by 89 publications

(20 citation statements)

References 49 publications

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“…The prognosis of infectious vasculopathy in our study was poor. Cerebrovascular complications have been reported to determine an unfavorable outcome in acute bacterial meningitis [17], VZV infection of the CNS [25,32], and neuroborreliosis [33,34]. Our study confirms these results.…”

Section: Discussionsupporting

confidence: 90%

Infectious Vasculopathy of Intracranial Large- and Medium-Sized Vessels in Neurological Intensive Care Unit: A Clinico-Radiological Study

et al. 2010

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Section: Discussionsupporting

confidence: 90%

Infectious Vasculopathy of Intracranial Large- and Medium-Sized Vessels in Neurological Intensive Care Unit: A Clinico-Radiological Study

et al. 2010

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“…However, cases of acute stroke-like symptoms and chronic encephalitis have also been described [2, 7]. In clinical practice, patients are usually categorized into acute neuroborreliosis (symptom duration < 6 months) and late manifestation/chronic neuroborreliosis (symptom duration > 6 months) [4, 8].…”

Section: Introductionmentioning

confidence: 99%

Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization

et al. 2017

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BackgroundNeuroborreliosis represents a relevant infectious disease and can cause a variety of neurological manifestations. Different stages and syndromes are described and atypical symptoms can result in diagnostic delay or misdiagnosis. The aim of this retrospective study was to define the pivotal neurological deficits in patients with neuroborreliosis that were the reason for admission in a hospital.MethodsWe retrospectively evaluated data of patients with neuroborreliosis. Only patients who fulfilled the diagnostic criteria of an intrathecal antibody production against Borrelia burgdorferi were included in the study.ResultsSixty-eight patients were identified with neuroborreliosis. Cranial nerve palsy was the most frequent deficit (50%) which caused admission to a hospital followed by painful radiculitis (25%), encephalitis (12%), myelitis (7%), and meningitis/headache (6%). In patients with a combination of deficits, back pain was the first symptom, followed by headache, and finally by cranial nerve palsy. Indeed, signs of meningitis were often found in patients with neuroborreliosis, but usually did not cause admission to a hospital. Unusual cases included patients with sudden onset paresis that were initially misdiagnosed as stroke and one patient with acute delirium. Cerebrospinal fluid (CSF) analysis revealed typical changes including elevated CSF cell count in all but one patient, a blood-CSF barrier dysfunction (87%), CSF oligoclonal bands (90%), and quantitative intrathecal synthesis of immunoglobulins (IgM in 74%, IgG in 47%, and IgA in 32% patients). Importantly, 6% of patients did not show Borrelia specific antibodies in the blood.ConclusionIn conclusion, the majority of patients presented with typical neurological deficits. However, unusual cases such as acute delirium indicate that neuroborreliosis has to be considered in a wide spectrum of neurological diseases. CSF analysis is essential for a reliable diagnosis of neuroborreliosis.

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“…Our report adds another possible association to the spectrum of previously reported manifestation of Lyme disease that deserves further study [10][11][12]. Worsening of CNS symptoms despite appropriate antibiotic treatment should lead physicians to consider CSVT also in patients with neuroborreliosis, but also prompt testing for LNB in cases of CSVT of undetermined origin [13,14].…”

Section: Discussionmentioning

confidence: 72%