Strokes and Lyme
Lyme neuroborreliosis mimics stroke: a case report. Arch Phys Med Rehabil. 2000 Apr;81(4):519-21.Zhang Y, Lafontant G, Bonner FJ Jr. Department of Physical Medicine and Rehabilitation, Graduate Hospital, Philadelphia, PA, USA. Abstract: Lyme neuroborreliosis is diagnostically challenging because of its diverse manifestations. The well-documented neurologic spectrum includes lymphocytic meningitis, cranial neuropathy, and radiculoneuritis in the early disseminated stage; and peripheral neuropathy, chronic encephalomyelitis, and mild encephalopathy in the late persistent stage. This case report describes a 74-year-old man who developed progressive left hemiparesis and facial palsy. The patient was hospitalized to rule out a cerebral vascular accident. The diagnosis of Lyme borreliosis was established with serologic studies. The patient was treated with intravenous ceftriaxone and responded with rapid clinical and functional recovery. Lyme neuroborreliosis presenting as hemiparesis has rarely been reported. Prompt diagnosis and treatment appear to facilitate symptomatic relief and prevent persistent neurologic deficits. PMID: 10768546 [PubMed - indexed for MEDLINE]
Cerebral vasculitis and stroke in Lyme neuroborreliosis. Two case reports and review of current knowledge.
Cerebrovasc Dis. 2008;26(5):455-61. doi: 10.1159/000155982. Epub 2008 Sep 23.
Topakian R, Stieglbauer K, Nussbaumer K, Aichner FT.
Source: Department of Neurology, Academic Teaching Hospital Wagner-Jauregg, Linz, Austria. raffi.topakian@hotmail.com
Abstract: We report on 2 patients with cerebral vasculitis and stroke due to Lyme neuroborreliosis (LNB). Both patients had a prodromal stage involving headaches, and showed meningeal enhancement in addition to ischemic infarctions on brain magnetic resonance imaging and diffuse vasculitis on vascular imaging. Serological and cerebrospinal (CSF) fluid studies confirmed the diagnosis of active LNB. Ceftriaxone for 3 weeks led to an excellent recovery and improvements in the CSF examination findings. Stroke physicians should be aware of this rare presentation of LNB. A review of the current knowledge on cerebral vasculitis due to LNB is provided.
Cerebrovasc Dis. 2008;26(5):455-61. doi: 10.1159/000155982. Epub 2008 Sep 23.
Topakian R, Stieglbauer K, Nussbaumer K, Aichner FT.
Source: Department of Neurology, Academic Teaching Hospital Wagner-Jauregg, Linz, Austria. raffi.topakian@hotmail.com
Abstract: We report on 2 patients with cerebral vasculitis and stroke due to Lyme neuroborreliosis (LNB). Both patients had a prodromal stage involving headaches, and showed meningeal enhancement in addition to ischemic infarctions on brain magnetic resonance imaging and diffuse vasculitis on vascular imaging. Serological and cerebrospinal (CSF) fluid studies confirmed the diagnosis of active LNB. Ceftriaxone for 3 weeks led to an excellent recovery and improvements in the CSF examination findings. Stroke physicians should be aware of this rare presentation of LNB. A review of the current knowledge on cerebral vasculitis due to LNB is provided.
Ischemic stroke caused by neuroborreliosis
Arch Pediatr. 1999 Dec;6(12):1302-5. [Article in French]
Laroche C, Lienhardt A, Boulesteix J.
Source: Service de pédiatrie II, CHU Dupuytren, Limoges, France.
Abstract: Ischemic stroke in children is rare and its etiology is frequently unknown.
CASE REPORT: We report the case of a nine-year-old boy who presented a right ischemic lenticular stroke due to neuroborreliosis, with a good outcome after antibiotic treatment.
CONCLUSION: We suggest that it is important to search for neuroborreliosis in case of an ischemic stroke in children; the study of cerebral spinal fluid is a good diagnostic marker.
Arch Pediatr. 1999 Dec;6(12):1302-5. [Article in French]
Laroche C, Lienhardt A, Boulesteix J.
Source: Service de pédiatrie II, CHU Dupuytren, Limoges, France.
Abstract: Ischemic stroke in children is rare and its etiology is frequently unknown.
CASE REPORT: We report the case of a nine-year-old boy who presented a right ischemic lenticular stroke due to neuroborreliosis, with a good outcome after antibiotic treatment.
CONCLUSION: We suggest that it is important to search for neuroborreliosis in case of an ischemic stroke in children; the study of cerebral spinal fluid is a good diagnostic marker.
Acute hemiparesis revealing a neuroborreliosis in a child. Arch Pediatr. 2008 Jan;15(1):41-4. Epub 2007 Dec 26. [Article in French] Rénard C, Marignier S, Gillet Y, Roure-Sobas C, Guibaud L, Des Portes V, Lion-François L. Service de neurologie, hôpital Debrousse, 29, rue des Soeurs Bouvier, 69322 Lyon cedex 05, France.
Abstract: We report on a 11-year-old boy who had 2 acute hemiparesis episodes over a period of 1 month. He suffered from headache and fatigue since 1 year. He could not remember neither a tick bite nor a local erythematous skin lesion. The diagnosis of neuroborreliosis was based on intrathecal production of specifics antibodies. Furthermore, the CSF/blood glucose ratio was decreased (0.14), which was rarely described. Cranial MRI showed left capsulothalamic inflammation and a vasculitis. The patient was successfully treated by ceftriaxone. Neuroborreliosis should be considered in all children with stroke-like episode, even in the absence of a history of a tick bite. PMID: 18155890 [PubMed - indexed for MEDLINE]
Abstract: We report on a 11-year-old boy who had 2 acute hemiparesis episodes over a period of 1 month. He suffered from headache and fatigue since 1 year. He could not remember neither a tick bite nor a local erythematous skin lesion. The diagnosis of neuroborreliosis was based on intrathecal production of specifics antibodies. Furthermore, the CSF/blood glucose ratio was decreased (0.14), which was rarely described. Cranial MRI showed left capsulothalamic inflammation and a vasculitis. The patient was successfully treated by ceftriaxone. Neuroborreliosis should be considered in all children with stroke-like episode, even in the absence of a history of a tick bite. PMID: 18155890 [PubMed - indexed for MEDLINE]
Intracerebral haemorrhage as a manifestation of Lyme neuroborreliosis?
Eur J Neurol. 2003 Jan;10(1):99-101.
Scheid R, Hund-Georgiadis M, von Cramon DY.
Source: Day Clinic of Cognitive Neurology, University of Leipzig, Germany. scheid@cns.mpg.de
Abstract: Lyme Neuroborreliosis (LNB) has repeatedly been reported to cause cerebral vasculitis. However, there is no reliable information about the incidence of cerebral vessel affection. The majority of reports deal with ischaemic consequences, and there are a few reports of subarachnoid haemorrhage (SAH). We report a case of otherwise unexplained intracerebral haemorrhage (ICH) where clinical and laboratory tests have shown LNB. Late stage LNB might not only cause ischaemic, but haemorrhagic stroke as well.
Eur J Neurol. 2003 Jan;10(1):99-101.
Scheid R, Hund-Georgiadis M, von Cramon DY.
Source: Day Clinic of Cognitive Neurology, University of Leipzig, Germany. scheid@cns.mpg.de
Abstract: Lyme Neuroborreliosis (LNB) has repeatedly been reported to cause cerebral vasculitis. However, there is no reliable information about the incidence of cerebral vessel affection. The majority of reports deal with ischaemic consequences, and there are a few reports of subarachnoid haemorrhage (SAH). We report a case of otherwise unexplained intracerebral haemorrhage (ICH) where clinical and laboratory tests have shown LNB. Late stage LNB might not only cause ischaemic, but haemorrhagic stroke as well.
Subarachnoid hemorrhage due to Borrelia burgdorferi-associated vasculitis.
Eur J Neurol. 2006 May;13(5):536-8.
Jacobi C, Schwark C, Kress B, Hug A, Storch-Hagenlocher B, Schwaninger M.
Source: Department of Neurology, Ruprecht-Karl University, Heidelberg, Germany.
christian_jacobi@med.uni-heidelberg.de
Abstract: We report the case history of a patient who suffered a subarachnoid hemorrhage (SAH) in association with early Lyme neuroborreliosis. After a tick bite, this patient developed erythema chronicum migrans and complained of stinging radicular pain in both legs. A computed tomography (CT) scan was performed because of acute headache and nuchal rigidity, which revealed an occipital SAH. Cerebrospinal fluid analysis provided further evidence of acute neuroborreliosis. Digital substraction angiography showed irregularities in the right posterior cerebral artery, which might be due to vasculitis, but no aneurysms.
Eur J Neurol. 2006 May;13(5):536-8.
Jacobi C, Schwark C, Kress B, Hug A, Storch-Hagenlocher B, Schwaninger M.
Source: Department of Neurology, Ruprecht-Karl University, Heidelberg, Germany.
christian_jacobi@med.uni-heidelberg.de
Abstract: We report the case history of a patient who suffered a subarachnoid hemorrhage (SAH) in association with early Lyme neuroborreliosis. After a tick bite, this patient developed erythema chronicum migrans and complained of stinging radicular pain in both legs. A computed tomography (CT) scan was performed because of acute headache and nuchal rigidity, which revealed an occipital SAH. Cerebrospinal fluid analysis provided further evidence of acute neuroborreliosis. Digital substraction angiography showed irregularities in the right posterior cerebral artery, which might be due to vasculitis, but no aneurysms.
