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Lyme neuroborreliosis — Clinical Guidelines

Overview

Lyme neuroborreliosis (LNB) can present with cerebrovascular complications, including stroke-like phenomena, particularly affecting the posterior circulation in both pediatric and adult populations. These manifestations often involve vasculitis and inflammatory brain changes.

Diagnosis

Clinical Presentation: Acute neurological deficits, cerebellar/brainstem dysfunction, meningeal signs 1 2 3.

Serological Confirmation: Positive serology for Borrelia burgdorferi 1 2 3.

Imaging: MRI with gadolinium enhancement showing vessel wall abnormalities, multifocal cerebral vasculitis, and ischemic lesions 3 4.

Lumbar Puncture: Lymphocytic pleocytosis and intrathecal synthesis of antibodies 1.

Management

Antibiotics: Intravenous ceftriaxone or penicillin (e.g., bencylpenicillin) 5 6.

Adjunctive Therapy: Antiaggregants and corticosteroids may be considered for vasculitis and inflammation 2.

Special Populations

Pediatrics: Pediatric stroke due to LNB often presents with cerebellar/brainstem dysfunction and multifocal vasculitis; incidence is rare but significant 1 2 3.

Adults: Meningovascular form with posterior circulation involvement; rapid recovery possible with appropriate antibiotic therapy 5 6.

Key Recommendations

Consider LNB in the differential diagnosis of unexplained cerebral vasculitis and stroke, especially with multifocal lesions and posterior circulation involvement (Evidence: Moderate 2 3).

Perform gadolinium-enhanced MRI to identify vessel wall abnormalities and support the diagnosis of vasculitis in LNB-related stroke (Evidence: Moderate 3).

Initiate intravenous antibiotic therapy targeting Borrelia burgdorleri for confirmed cases of LNB with neurological complications (Evidence: Moderate 5 6).

References

1 Monteventi O, Steinlin M, Regényi M, Roulet-Perez E, Weber P, Fluss J. Pediatric stroke related to Lyme neuroborreliosis: Data from the Swiss NeuroPaediatric Stroke Registry and literature review. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2018. link 2 Kurian M, Pereira VM, Vargas MI, Fluss J. Stroke-like Phenomena Revealing Multifocal Cerebral Vasculitis in Pediatric Lyme Neuroborreliosis. Journal of child neurology 2015. link 3 Lebas A, Toulgoat F, Saliou G, Husson B, Tardieu M. Stroke due to lyme neuroborreliosis: changes in vessel wall contrast enhancement. Journal of neuroimaging : official journal of the American Society of Neuroimaging 2012. link 4 Oksi J, Kalimo H, Marttila RJ, Marjamäki M, Sonninen P, Nikoskelainen J et al.. Inflammatory brain changes in Lyme borreliosis. A report on three patients and review of literature. Brain : a journal of neurology 1996. link 5 Olsson JE, Zbornikova V. Neuroborreliosis simulating a progressive stroke. Acta neurologica Scandinavica 1990. link 6 May EF, Jabbari B. Stroke in neuroborreliosis. Stroke 1990. link

Lyme neuroborreliosis