Frontiers in Neurology,  20 April 2017

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

imageAdam Garkowski1*, imageJoanna Zajkowska2, imageAgata Zajkowska3, imageAlina Kułakowska3,imageOlga Zajkowska4, imageBożena Kubas5, imageDorota Jurgilewicz5, imageMarcin Hładuński5 andimageUrszula Łebkowska1
  • 1Department of Radiology, Medical University of Białystok, Białystok, Poland
  • 2Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Białystok, Poland
  • 3Department of Neurology, Medical University of Białystok, Białystok, Poland
  • 4Faculty of Applied Informatics and Mathematics, Warsaw University of Life Sciences SGGW, Warsaw, Poland
  • 5Independent Department, Laboratory of Molecular Imaging, Medical University of Białystok, Białystok, Poland

Background: Lyme 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 methods: We conducted a systematic review of literature between May 1987 and December 2016 with patients who presented with cerebrovascular course of LNB.

Results: This 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 –transient ischemic attack (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%.

Conclusion: Cerebral 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.

Supplementary Material
The Supplementary Material for this article can be found online at  **This data shows year of publication, signs and symptoms, CSF protein level, Radiological/histopathological features, treatment, and outcome (complete or incomplete).  (Treatments included:  penicillin, steroids, ceftriaxone, doxycycline, amoxicillin, azithromycin, probenecid, cyclophosphamide, cefotaxime, and ampicillin)