Cerebrovascular Manifestations of Lyme Neuroborreliosis—A Systematic Review of Published Cases

Abstract

BackgroundLyme neuroborreliosis (LNB) is a disease caused by spirochete Borrelia burgdorferi, involving the nervous system. It usually manifests as lymphocytic meningoradiculitis, but in rare cases, it can also lead to cerebrovascular complications. We aimed to perform a systematic review of all reported cases of LNB complicated by central nervous system vasculitis and stroke or transient ischemic attack (TIA).Materials and methodsWe conducted a systematic review of literature between May 1987 and December 2016 with patients who presented with cerebrovascular course of LNB.ResultsThis study included 88 patients with a median age of 46 years. The median interval from onset of symptoms suggesting Lyme disease to first symptoms of cerebrovascular manifestations of LNB was 3.5 months. The most common cerebrovascular manifestation of LNB was ischemic stroke (76.1%), followed by TIA (11.4%). The posterior circulation was affected alone in 37.8% of patients, the anterior circulation in 24.4% of patients, and in 37.8% of cases, posterior and anterior circulations were affected simultaneously. The most common affected vessels were middle cerebral artery—in 19 cases, basilar artery—in 17 cases, and anterior cerebral artery—in 16 cases. A good response to antibiotic treatment was achieved in the vast number of patients (75.3%). The overall mortality rate was 4.7%.ConclusionCerebral vasculitis and stroke due to LNB should be considered, especially in patients who live in or have come from areas with high prevalence of tick-borne diseases, as well as in those without cardiovascular risk factors, but with stroke-like symptoms of unknown cause.

Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis: nationwide population based cohort study

“…It is also consistent with reports of meningovascular involvement leading to lacunar infarctions secondary to obliteration of small penetrating arteries, primarily in patients with chronic Lyme neuroborreliosis. 26 …”

Secondary dementia due to Lyme neuroborreliosis

“…Disorders that commonly lead to a slowly progressive dementia such as AD and frontotemporal dementia rarely present with a rapid course [ 24 ]. Cognitive impairment with sudden onset or with stepwise deterioration in combination with hemiparesis, hemianopsia or diplopia indicating vascular dementia [ 25 ] have also been reported in rare cases of vasculitis due to LNB and might be the cause of irreversible dementia in LNB [ 26 – 28 ].…”

Imaging in Lyme neuroborreliosis

“…LNB vasculitis is presumed to be caused by the inflammatory response to the spirochetal infection [ 16 ]. A German study calculated a 0.3% chance of cerebral vasculitis in Lyme borreliosis, and there may be an affinity for involvement of the posterior cerebral circulation in LNB vasculitis [ 44 , 86 ]. Imaging is necessary to recognise this type of complication (Fig.…”